Internal Family Systems Therapy for Addictions: Trauma-Informed, Compassion-Based Interventions for Substance Use, Eating, Gambling and More

So often, addiction is viewed as a disease or an uncontrollable habit that signals a lack of willpower. In Internal Family Systems (IFS) Therapy for Addictions, IFS educator Cece Sykes, IFS author Martha Sweezy, and IFS founder, Richard Schwartz, suggest a paradigm shift. Rather than viewing addiction as a pathology, they propose that it reflects the behaviour of polarised, protective parts struggling to manage underlying emotional pain.

In this manual, therapists will learn how to access their core, compassionate Self and collaborate with clients in befriending protective parts who engage in addictive processes; healing the vulnerable, wounded parts they protect; and restoring balance in their system.

Included inside:

• Experiential exercises to help clients (and therapists) get to know their own parts
• Guidelines for conducting assessments in an engaging, collaborative way
• Clear strategies for negotiating internal conflict and navigating polarisation between opposing parts
• Case examples annotated with step-by-step explanations
• Downloadable worksheets, handouts, and meditations

Table of Contents

Preface ix

Acknowledgments xi

Introduction xiii

Section I An Overview of Internal Family Systems Therapy 1

• The Core Assumptions of IFS 1
• Psychic Multiplicity Is Not a Pathology 2
• Managers: Proactive and Future-Focused 2
• Firefighters: Reactive and Present-Focused 4
• Exiles: Emotionally Overwhelming and Past-Oriented 7
• Self Is the Heart of the Matter 8
• Basic Concepts for the Clinical Application of IFS 9

Section II Conceptualizing Addiction 19

• Attachment Wounds, Trauma, and the Addictive System 19
• The Social Context of Addiction: Polarizations Writ Large 20
• Polarizations Between Protectors 21
• Is Psychotherapy Enough? 23

Section III Assessment 25

• Creating a Context for Collaboration and Hope 26
• From Standard Assessment to IFS Assessment 32
• When a Firefighter Presents First 34
• When a Manager Presents First 39
• When an Exile Presents First 43

Section IV Treatment 47

• The Therapist Role: Connection and Collaboration 47
• Our Agenda 53
• The Addiction Polarity 53
• Intervening in Polarizations 61
• De-escalating the Manager-Firefighter Polarity 63
• Calming the Addictive Polarity 74
• Getting to Know Firefighters 74
• Asking about Outside influences 82
• Befriending Managers 83
• Reorienting Back to Firefighters 90
• When Firefighters Run the System 93
• Exile Interventions 96
• Witnessing and Unburdening 108
• Backlash 119
• Recovery and Recurrence 123

Conclusion 127

References 129

"Now more than ever, we need widely available compassionate treatment approaches to addiction and substance use disorder, yet many generalist therapists avoid seeing clients who need help with addictions. Sometimes this is because they were taught this wasn't within their scope of practice by supervisors. Or it may be because they've had intimidating experiences with unrelenting or overwhelming addictive behavior, they've experienced the wrath of an angry client, they fear the client will overdose, they can't tolerate the sinkhole of the client's ambivalence, or they've felt futile and useless after repetitive cycles of addictive recurrences and bearing witness to a client's decline. If any of this rings a bell and you would prefer to feel empowered with clients who engage in addictive processes, read this book. It illustrates three master clinicians using the innovative internal family systems (IFS) approach to help clients deescalate inner conflicts and navigate addictive behaviors."
- Zev Schuman-Olivier, MD, director of the Center for Mindfulness and Compassion and director of Addiction Research, Cambridge Health Alliance, and assistant professor in psychiatry, Harvard Medical School

"Addiction experts usually come in three flavors: treatment providers who tout their explicit formula for recovery, sociopolitical thinkers who understand addiction as a complex societal ill, and students of child development who recognize the trauma-strewn pathways that result in addiction and self-harm. How refreshing, then, and how remarkably comprehensive and satisfying, to see an amalgamation of all three perspectives in Internal Family Systems Therapy for Addictions, which then goes on to teach us precisely how to intervene. As a onetime addict, addiction researcher, and clinical psychologist, I'm blown away by the impact of Sykes and colleagues' IFS-guided approach to therapy. For nearly 10 years I have used this approach with my addicted clients, and there's simply nothing out there with such precision and power to help. IFS in general, and the authors' step-by-step formula for applying IFS impeccably with this difficult population, targets addiction where it lives-in the struggle between overcontrol and abandon. As these authors clarify through their singular insights and expertise, it's a struggle that gets resolved through focused attention and self-compassion, not by taking sides. This book is for therapists, clients, educators, coaches, and clinical researchers who've been trying to make sense of the convoluted literature and practice guidelines intended to help those who suffer from addictive disorders. It brings clarity to the chaos, both intellectually and pragmatically, but its most impressive achievement is to map out a treatment approach that actually makes a difference."
- Marc Lewis, PhD, C.Psych, professor emeritus (University of Toronto), clinical psychologist, and author of The Biology of Desire: Why Addiction Is Not a Disease and Memoirs of an Addicted Brain