Internal Family Systems Therapy: How It Works & What to Expect

Core Concepts of Internal Family Systems Therapy

IFS consists of working with the Self and Parts (Exiles, Managers, and Firefighters).

Self

The first core concept of IFS is the existence of the Self. The Self is the innate presence within each person that is the pure essence of who they are. It is inherently good and whole, and cannot be broken or corrupted. When a person is Self-led, their system is balanced and all parts are acting in harmony with one another. Sometimes the Self and other parts become blended, obscuring the Self. When this happens, the first step is to differentiate the Self from the blended parts.

Being in Self is marked by the 8 C’s of self-energy:⁵

1. Curiosity
2. Calm
3. Clarity
4. Connectedness
5. Confidence
6. Courage
7. Creativity
8. Compassion

When a person is in Self, they typically describe feeling one or more of the qualities listed above. In Self, the client can effectively communicate with their parts. Accessing Self is the first step in beginning to heal the system.

Parts

The second core concept of IFS is the existence of parts. Sometimes referred to as subpersonalities or families, each part has their own beliefs, thoughts, and feelings. They may be a different age or gender than the client.¹ All parts act from a place of positive intention. There are no bad parts, only bad roles.

When a part feels threatened and doesn’t trust the Self, they act out to try to protect the system. Because parts are often stuck in time or polarized with one another, the behaviors they elicit are extreme or out of sync with reality. When parts trust the Self, and feel understood and appreciated, they take on positive roles and the whole system acts in harmony.

There are three broad categories of parts:

1. Exiles

Exiles are the parts that carry the most extreme memories and feelings. They are often some of the youngest parts of the system. They hold the experiences of abuse, neglect, humiliation, and shame. A part becomes an exile when the trauma they have endured is so great that other parts effectively lock them away in an effort to protect the system from becoming overwhelmed. It takes an incredible amount of energy to keep exiles out of conscious awareness. Exiled parts may appear as younger versions of the client.

2. Managers

Managers are the proactive protectors of the system. Their goals include keeping the system stable and being prepared. Managers look for ways to control the system so that exiled parts are kept out of awareness. The fear of most managers is that the exiled parts might come to the surface and overwhelm the system with the intensity of the memories and feelings they hold. They often imitate the Self with such effectiveness that they appear to actually be the Self. Managers may take the form of a critical parent or overbearing boss.

3. Firefighters

Firefighters are the reactive protectors of the system. Firefighters step in when an exiled part has broken through the managers’ defenses. Their goal is to stop the system from feeling the pain that exiles carry. This may initially start with less intense behaviors such as smoking cigarettes, seeking out adrenaline-producing experiences, or overworking. However, firefighters are often polarized with managers who despise the ways firefighters act out. This polarity can cause the tactics firefighters use to escalate to extremes such as binge eating, self-harm or suicide attempts, or drug use.

The Unburdening Process

The process of unburdening is the key to healing exiles and other wounded parts. In Self, the client listens to the exile’s experience until the exile feels understood, accepted, and loved. Then the client offers the exile a do-over. The part tells the Self what it needed at the time, and the client does what the part needed.

When the part is ready, the client’s Self helps the part to unburden- ceremonially releasing the painful memories, feelings, or beliefs using imagery. Then the client invites the part into the present and helps it find a new role. The protector parts are invited to meet the healed part and begin finding new, healthy patterns of interaction.¹

What’s the Goal of IFS?

The initial goal of IFS therapy is to help the client access their Self and befriend the managers and firefighters. Then, in Self, the goal is for the client to access exiled parts and heal them through the unburdening process. The ultimate goal of IFS is to increase the client’s access to Self so that they can be more Self-led. This process naturally allows clients to reach other goals they may have such as decreasing anxiety, improving their relationships, or recovering from trauma.

What Can Internal Family Systems Therapy Help With?

Originally, IFS was developed by Richard Schwartz in the 1980s to help people suffering from eating disorders. Since then, the model has been used to treat a wide range of mental health diagnoses as well as non-clinical issues. The disorders that Internal Family Systems can help with range from anxiety to depression to suicidal ideation. IFS is also used for people struggling with issues related to self-esteem, anger, shame, and more.

Internal Family Systems Therapy Examples

The experience of IFS therapy is a very individualized one as no two clients have exactly the same parts. Moreover, each client will experience their parts in their own way. Some clients may experience parts as bodily sensations like tension in the shoulders or a knot in the stomach. Others may experience parts as emotions, like worry or rage, or in visual images in their mind’s eye like a scolding teacher or a terrified child. When the Self communicates with a part, that communication may be experienced as a stream of thoughts or as an internal dialogue.

Regardless of the presenting issue, IFS therapy follows the same general process. It begins with differentiating the Self and getting to know the protector parts. The therapist will begin by asking “What part needs attention today?” The part that comes up, especially early in therapy, is likely to be a protector part. The therapist will ask the client to ask the part questions. They might include “Where is that part in your body? Does it have a name? How does it feel about being in session today? What is its job? What is it afraid will happen if it stops doing its job?”

Getting to know and befriend protector parts can take time. Throughout the process, the therapist will ask the client how they feel towards the part they’re working with. If the client says something that embodies any of the 8 C’s of self-energy, the therapist knows the client is in Self. If their response indicates that they feel angry, scared, disappointed, or any other emotion that doesn’t suggest self-energy, it means another part has come up. The therapist will help the client turn their attention to that part, and begin working with it until it is comfortable stepping back.

Once the client has begun to establish more trusting relationships between their Self and parts, the client can begin asking the protector parts to “step back.” As the parts step back, the client can access exiled parts. When the client meets an exile, the unburdening process can begin. As more and more parts are unburdened, clients experience relief of problematic behaviors and symptoms.

Internal Family Systems Therapy Example: Jane

For example, Jane has been experiencing anxiety every time she has to give a presentation at work. She’s always had some anxiety about presenting but lately it’s gotten worse. It’s beginning to impact her ability to do her job and she’s afraid that she might get fired. She decides to go to therapy to see if she can resolve her anxiety.

An IFS therapist would ask Jane what part needs attention in the moment. Jane shares that she feels nauseous all the time, but particularly on days when she must present. Her nausea has been so bad that she’s missed a handful of days of work in the last month. The therapist would ask Jane to talk to the nauseous part. As the therapist guides Jane through getting to know it, she learns that the nausea is afraid that if Jane presents, something terrible will happen. It’s trying to protect Jane by making her so nauseous that there’s no chance she’ll present.

The therapist continues to guide Jane through talking to the nauseous part. As Jane develops a more trusting relationship with the part, she’s able to ask it to step back and let her meet the exiled part. The therapist guides Jane in meeting and talking to the exile. Jane shares that the part looks like her as an 8 year old. With the therapist asking guiding questions, Jane remembers that when she was 8 she was standing in class doing show and tell with her favorite stuffed animal. Classmates began making fun of her for bringing a stuffed animal and called her names. Jane began to cry and the teacher asked the class to be quiet but didn’t say anything to Jane. She felt humiliated and ashamed.

Jane goes through the unburdening process with the exile and is able to bring it into the present. She introduces the nauseous part to it. It begins to understand that the exile has been healed and it won’t be triggered when Jane presents. The nauseous part no longer has to work so hard to keep Jane from presenting. It knows the system won’t become overwhelmed by the shame and humiliation of the memory from when she was 8. Jane’s nausea is significantly reduced. She continues to work with other parts that are activated by the idea of her giving a presentation. As she befriends and heals them, the anxiety that led her to seek therapy is resolved.

How Much Does Internal Family Systems Therapy Cost?

The total cost of therapy often depends on the number of sessions it takes to resolve the issue a client is seeking treatment for. A session with an IFS therapist typically ranges between $120 and $180. Therapists who offer sliding scale fees may provide IFS therapy for as low as $20 a session while fully certified IFS therapists may charge over $200 a session.

Insurance coverage for mental health ranges greatly from company to company. Not all insurance companies will cover IFS therapy. If you are interested in using your insurance, be sure to call your insurance company and ask for specific details regarding your coverage.

Key questions to ask include:

• Does my plan cover sessions with an IFS therapist?
• Are there any mental health diagnoses that are not covered or are required to be treated with a different kind of therapy?
• Is there a limit to the number of sessions that will be covered?

How to Find an Internal Family Systems Therapist

IFS therapy is typically provided by licensed mental health professionals such as licensed mental health counselors, licensed marriage and family therapists, and psychologists. A good place to start when looking for a provider that uses IFS is the IFS Institute’s webpage. Be sure to look if the therapist is licensed to practice in your state. Other online directories that list mental health providers in your area can help you find an IFS therapist near you.

If you are planning to use your health insurance, check with your insurance company for in-network providers by looking through their website or calling the number on the back of your card. Your insurance company may not be able to specify whether or not a therapist practices IFS, so don’t hesitate to call them or check out their website.

Who Is Able to Offer IFS Therapy?

In order to offer IFS therapy a therapist must have additional post-graduate training. This typically includes attending the IFS Institute’s Level 1 training, participating in consultation or supervision with other IFS therapists, and continuing education classes that focus on IFS. Becoming a fully certified IFS therapist requires two additional levels of training and is a costly and lengthy process that not all IFS practitioners will choose to undertake.

Key questions to ask when considering working with an internal family systems therapist:

• What are your credentials? Are you licensed to practice in my state?
• Have you worked with individuals experiencing concerns similar to mine?
• Do you have training in IFS?
• Would you recommend IFS for the reasons I’m seeking therapy?
• Do you only use IFS or do you integrate other theories? If so, what other theories do you use?

What to Expect at Your First Appointment

Your first appointment with an IFS therapist will likely begin with a review of informed consent and privacy practices, as well as going over any other paperwork the therapist or clinic requires. They may also go over information regarding logistics (e.g. scheduling, cancellation policies) and provide more information about themselves and how they practice therapy. If you have any questions over the information the therapist covers or shares, don’t hesitate to ask.

The rest of the session will primarily be devoted to assessment. The therapist will ask you questions to help them understand what has brought you to therapy. They will also ask what you would like to get out of working together. This is an important part of the therapeutic process because it informs the diagnosis (if applicable) and treatment plan that the therapist will develop. If there is time, the therapist may begin to introduce you to the language and general patterns of an IFS session.

Throughout your first session, you and the therapist will be beginning to build your therapeutic relationship. This will be an ongoing process, and is important to the success of therapy. A good therapeutic relationship is marked by respect, trust, and a sense of safety. Pay attention during your first session to how you feel while talking to the therapist.

Not every client will connect with every therapist and therefore, if you feel a disconnect, it may be wise to continue to meet with other therapists until you find a comfortable fit. The client-therapist relationship is one of the most important predictors of successful therapy outcomes.

If you decide to continue working with the therapist, your next sessions are likely to be focused on beginning to identify and build relationships with your parts. It can take some time to get used to the way IFS works, so don’t worry if it takes a few sessions to get comfortable with the process.

Is Internal Family Systems Therapy Effective?

Internal family systems therapy was designated as an evidence-based treatment in 2015. Although much of the evidence regarding the efficacy of IFS is anecdotal, major research studies are ongoing and will hopefully provide scientific evidence to support what IFS therapists consistently see.

Bessel van der Kolk, a Dutch psychiatrist and one of the leading researchers on trauma, has strongly backed the use of IFS. In his book, The Body Keeps the Score, van der Kolk details his own experience using IFS with clients suffering from traumatic experiences and relationship conflicts.⁶

Frank Anderson, a psychiatrist and leading mental health professional, has also championed the use of IFS. He is the former chairman/director of the Foundation for Self Leadership, a non-profit working to advance IFS research.

Key Studies

In 2015, the National Registry of Evidence-Based Practices and Programs (NREPP),  recognized IFS as an evidence-based psychotherapy model. In their independent, rigorous review NREPP found IFS to be an effective treatment for improving general functioning and well-being in regards to clients with chronic pain. It also found that IFS has promising outcomes for clients experiencing anxiety, depression, issues with self-concept, and physical health conditions.³ While more research is needed, the initial studies suggest that IFS therapy is an effective treatment for a range of mental health conditions and other issues.

The first major study that demonstrated the efficacy of IFS was focused on the use of IFS therapy with patients suffering from rheumatoid arthritis (RA). Published in 2013, it found that individuals suffering from joint pain due to RA experienced a decrease in overall pain and an increase in physical functioning. Those who received IFS therapy also experienced a decrease in self-assessed joint pain, a decrease in depressive symptoms, and an increase in self-compassion. At a one year follow up these results had been maintained.⁴

In 2017, a study published in the Journal of Marital and Family Therapy demonstrated the effectiveness of IFS therapy in treating depression. The study focused on women in college who had depressive symptoms. It noted that although CBT, interpersonal psychotherapy, and medication are often used to treat this group due to the evidence-based support of these methods, many clients do not improve with these treatment methods. IFS was used as an alternative treatment and was found to help reduce depressive symptoms.² While promising, additional studies will need to be done.

Risks of IFS

The activation of specific parts in response to trying to access exiled parts may cause an increase in problematic behaviors. It is important to move only as quickly as manager and firefighter parts are comfortable moving.

Other risks of IFS therapy include strong emotional reactions, a worsening of symptoms (usually temporary and common in the beginning of therapy), and lack of progress towards therapeutic goals. These risks are similar to other treatment approaches. Overall, the risks of IFS therapy are not any greater than the risks of other forms of psychotherapy.

Criticisms of IFS

The primary criticism of IFS surrounds the lack of scientific research to support its efficacy. There is substantial anecdotal evidence that supports the use of IFS to treat a range of mental health conditions and other issues. However, additional scientific research is needed to back up those claims. Nevertheless, this criticism may not be important at an individual level provided the therapy yields the relief and positive change the client is seeking.

Critics of IFS also point to the lack of acknowledgement paid to the effects of genetics and biochemistry on mental health. Because IFS takes a fundamentally non-pathologizing stance towards mental health, the use of psychiatric medications are not typically part of an IFS therapist’s recommendation. Mental health professionals who conceptualize mental health disorders as at least partially biochemical in nature are critical of the lack of attention paid to those factors in IFS.

How Is Internal Family Systems Therapy Different Than Other Therapy Options?

IFS is different from other models of psychotherapy in that it emphasizes the natural multiplicity of the mind. It is less solution-focused than most modern psychotherapy models. Instead it focuses on helping clients become more Self-led with the understanding that as Self-leadership increases, disordered thoughts or behaviors naturally decrease.

Many IFS therapists will use an integrative approach, with the IFS model serving as the overarching framework for understanding how healing and growth happens. Through the course of therapy, specific parts of a client may benefit from the integration of techniques from other psychotherapy models.

IFS vs CBT

Cognitive Behavioral Therapy (CBT) is a directive approach that focuses on changing a client’s thoughts in order to change their mood and behavior. It is the most extensively researched model of psychotherapy and can be used to treat a range of mental health disorders. CBT is solution-focused and teaches clients specific techniques to help them address symptoms that negatively impact their functioning.

In comparison to CBT, IFS is a much less directive and solution-focused approach. IFS therapy does not make any effort to change a client’s thoughts or teach skills to do so. Instead, IFS focuses on understanding where the thought is coming from in order to access the wounded parts that have distressing thoughts. In healing those parts, those thoughts naturally change. This causes a cascade effect in which emotions and behaviors are also changed.

IFS vs Person-Centered therapy

Person-centered therapy is a non-directive approach that emphasizes the client’s natural ability to self-actualize, or to grow and change in ways that help them reach their potential. It is a widely used psychotherapy model that tends to work best for clients with anxiety or depression and high motivation to change.

IFS and person-centered therapy are similar in that they both emphasize the client’s expertise in regards to their own life and their innate ability to move towards healing and growth. IFS utilizes concepts very similar to the “core conditions” of person-centered therapy. In person-centered therapy, the therapist creates space for the client to talk while they actively listen. In IFS therapy, the therapist facilitates communication between the client’s Self and their parts.

IFS vs Family Systems Therapy

Although Internal Family Systems Therapy and Family Systems Therapy sound very similar they have a key difference. IFS focuses on the inner workings of a client while Family Systems Therapy focuses on the ways family members interact with and affect one another. IFS therapy was inspired, in part, by Family Systems.

Richard Schwartz, the creator of IFS, was a trained Family Systems therapist. His understanding of how family members interact informed his understanding of a client’s internal parts. While IFS can be used in family therapy, it is more often used in individual therapy.