EMDR Therapy and Internal Family Systems (IFS)

Guest Blog Post by Daphne Fatter, PhD

Tell us a little bit about you, your experience becoming an EMDR therapist, and your experience working with IFS as well.

I am a licensed psychologist in Dallas, Texas, with a telehealth private practice. I am also an active mom to three children. I was trained in EMDR almost 20 years ago and am a Certified EMDR therapist and a Consultant in Training (CIT). I am also certified in IFS and an IFS Clinical Consultant.

When I became trained in IFS, I immediately could see the connections IFS has with EMDR. As I started using IFS with clients, I could see how clients’ parts were showing up as mental health symptoms. I witnessed parts transform when they experienced a connection to the client’s Self (i.e., their core loving essence). In using EMDR, I couldn’t help noticing when a part of the client’s system was upset or distressed. I also noticed that parts were connected to the memory networks we would focus on in EMDR. As I began integrating IFS into the 8 Phases of EMDR, I experienced clients responding well. In particular, clients had consistent positive results when they received consent from their protective parts to do EMDR and also when I used IFS interventions to help them move through trauma processing in EMDR as needed.

Can you briefly help us understand a little more about IFS and why it has become more popular recently in therapeutic settings?

Internal Family Systems (IFS) is a model that believes the psyche is divided into subpersonalities called parts. While many models in our field work with parts, IFS is unique as a parts model in many ways–for one, it believes everyone has Self, which is one’s core loving essence that is unharmed by trauma and can offer secure attachment for one’s parts. IFS offers a clear roadmap of how clients can connect to their own Self to re-organize their internal system of parts so that clients can become Self-led. An analogy I often use with clients to describe being Self-led is that being Self-led is having a sports team of players following the leadership of the coach. The players work together as a team in harmony towards the same goals. This differs from being parts-led, which is when the team players are trying to function in isolation on their own, not working together, or are in significant conflict with each other without a coach. IFS helps guide clients to be more Self-led so their internal parts work as a harmonious team and follow the guidance and leadership of their Self.

From an IFS perspective, mental health symptoms are due to internal parts of a client that are stuck in extreme roles or states trying to help the client in the only ways they know how. In IFS, the therapist helps shift a client’s system to be more Self-led by supporting a relational connection between a client’s Self and their parts, ultimately helping liberate parts to share their naturally valuable gifts rather than being stuck in roles that trauma or life adversity forced them in. When a client is connecting to their parts from their own Self, their parts transform, and internal healing happens. When a client’s Self is present and in connection with the client’s parts, Self can provide a relationally emotionally corrective experience for the parts, witness parts’ stories, traumas, and lived experiences. Intrapersonally, this creates an internal attachment repair in the client’s system so that parts can release any beliefs or burdens they carry (i.e., the Negative Cognition and associated feelings and body sensations from an EMDR lens).

Richard Schwartz, Ph.D., the founder of IFS, has worked hard to spread the word about IFS for the past 40 years. While research on IFS is still in its infancy, research has shown IFS to be effective in treating PTSD (Hodgdon, et al., 2021) depression (Haddock et al., 2017), and physical health conditions (Shadick et al., 2013). I think that all of Dr. Schwartz’s efforts, as well as the recent research on IFS for PTSD treatment, have contributed to a tipping point where more and more clinicians and clients are hearing about the effectiveness of IFS. Thus, IFS has become one of the fastest-growing therapy models, particularly in the United States, in the past four years.

IFS can also be integrated with many therapeutic modalities (e.g., somatic psychotherapies, sand tray therapy, art therapy, psychodrama, psychedelic-assisted psychotherapy), including EMDR, which is another reason why IFS has become so popular in recent years. Clinicians exposed to IFS tend to love it because they see not only the benefit for their clients but can also apply the IFS model to themselves and become more aware and connected with their own parts.

How can EMDR therapy and IFS complement each other in treatment? What successes have you seen?

Integrating IFS into EMDR supports a consent-based relational approach to treatment that helps honor the complexity of clients’ internal systems and clinically attunes to a client’s system where they are. This contributes to a strong working alliance, which we know contributes to positive therapy outcomes in and of itself. In my clinical experience, it also enhances an individualized treatment plan and provides an attachment-oriented approach, helping support repair between the client’s Self and their parts while also receiving the benefits of EMDR (Fatter, 2023).

While integrating IFS into EMDR can be beneficial to any client, this integrative approach can be especially beneficial to clients with complex trauma. Recent research recommends a multi-intervention and multi-method approach for complex trauma (Cloitre, 2020; Cloitre et al., 2020; Cloitre, 2021). Integrating IFS into EMDR meets this need for a multi-method approach for clients with more complex systems organized around trauma, including for clients with dissociative parts. By integrating IFS into EMDR, I have seen many successes in clients’ treatment in enabling more clients to tolerate EMDR ultimately making it more accessible to more clients as a treatment choice.

While IFS interventions can be integrated into all 8 Phases of EMDR treatment, I have found it particularly helpful to integrate IFS interventions during EMDR’s Phase 1 and Phase 2. By initially starting with IFS in Phase 1 and Phase 2 of EMDR’s 8-Phase model, the clinician can guide the client to befriend their own protective parts that may show up. These protective parts correlate to what we call a “blocking belief” in EMDR or parts of the client that have fears or concerns about doing EMDR or focusing on a particular target in EMDR. Clinicians can first use IFS to check in with protector parts by asking the client: “Do any parts of you have fears or concerns about doing EMDR on this target?” before proceeding to Phase 3. In my clinical experience, this simple IFS intervention can help decrease the risk of adverse reactions or decompensation between EMDR sessions by getting the consent of a client’s protective parts.

Are there any cautionary measures you would like to mention regarding using EMDR therapy and IFS?

When therapists integrate IFS-informed interventions into the 8 Phases of EMDR, it is crucial for clinicians to return to the EMDR protocol they are using to maintain fidelity to the 8 Phases of EMDR. For example, if the client is “looping” in Phase 4 trauma reprocessing, a clinician can use an IFS intervention to effectively help the client get unstuck. It’s important for the clinician to resume then Phase 4 trauma reprocessing rather than continue with the full IFS protocol.

Right now, there are only case studies (Krauze & Gomez, 2013; O’Shea Brown, 2020; Twombly & Schwartz, 2008) on integrating EMDR and IFS, so there is a need for more empirical research to support using IFS-informed EMDR and integrating these two models.

Are there any myths you’d like to bust about EMDR and IFS parts work?

Using IFS in therapy is not just talking about parts but inviting a client to be with their parts and learn how to relate and connect with their internal parts from the client’s own Self. The clinician is guiding the client through a process of facilitating bi-directional communication between the client’s Self and the client’s own parts (whether they are protective parts that are protective of an exile or exile parts, which are the vulnerable parts that hold the pain from life adversity, trauma, and attachment wounds).

In IFS, the goal is not to integrate parts into one unified being – IFS facilitates parts shifting their role in the system to an adaptive (rather than trauma-based) state where they have a choice in the internal system and can share their natural gifts in the system. Thus, IFS is not trying to ‘get rid’ of any parts or make them go away; IFS helps parts transform to optimal functioning. This fits beautifully with EMDR’s Adaptive Information Processing model, which can help clients transform distressing memories in a given traumatic neural network by connecting the neural network with more adaptive information. In IFS, the adaptive information comes from Self and is transmitted to any stuck parts through the relationship between parts and Self.

What multicultural considerations might EMDR therapists need to keep in mind regarding EMDR therapy and IFS?

There is a saying in IFS: “All parts are welcome.” IFS honors and respects each part of a client’s system through a non-pathological lens. It is important to honor that a client’s social location, intersectionality, and multiple identities the client embodies (e.g., cultural identity, racialized identity, gender identity, and sexual orientation, to name a few) will impact their parts, how they express themselves to the client, and how the parts within function in a client’s system. In applying IFS, clinicians trust that the client is the expert of their own internal system, and their parts hold wisdom to help support their healing.

Clinicians can integrate IFS with EMDR with any client, including children, teens, and adults. IFS honors that internal parts are impacted not only by their own lived experiences but also by previous generations through heirlooms (generational gifts and cultural strengths) and legacy burdens.

In IFS, there are two types of burdens parts can carry: personal burdens and legacy burdens. Personal burdens are negative cognitions and their associated feelings and body sensations based on a client’s lived experience. Legacy burdens refer to negative cognitions and their associated feelings and body sensations that have been handed down intergenerationally, ancestrally, and/or that have been absorbed in response to dominant culture or through historical trauma. Thus, legacy burdens are not based on the client’s own lived experience but have been handed down to the client. For example, if a client says, “My parent or grandparent had this belief too” or “This belief has always been there,” clinicians can invite curiosity and explore where the belief or burden came from (Sinko, 2017). This notion of legacy burdens corresponds with more recent approaches to intergenerational trauma in EMDR. For example, Dr. Karen Alter Reid has proposed the “4^th Prong” to EMDR’s original 3-pronged approach: Ancestral. Thus, in addition to the Past, Present, and Future in EMDR treatment, Ancestral would be added (Alter-Reid, 2023). When legacy burdens may arise in a client’s parts through IFS, a clinician can consider using a legacy-attuned EMDR protocol (e.g., Robinson, 2023).

For clinicians that are applying IFS and EMDR cross-culturally and/or are integrating IFS and EMDR to address racial trauma, intersectionality-based trauma, or oppression-based trauma, IFS can help support the clinician to access their own Self energy. There are eight distinctive aspects of Self: curiosity, compassion, calmness, connectedness, courage, creativity, clarity, and confidence. When clinicians are Self-led in their own systems, they have greater access to these qualities, particularly curiosity and compassion. This can help clinicians show up being present to their clients with cultural humility, which can contribute to an effective therapeutic relationship.

What is your favorite free resource that you would suggest to other EMDR therapists interested in learning more about using EMDR and IFS?

I was interviewed on a free IFS-oriented podcast called “The One Inside.” In the episode “Integrating IFS and EMDR,” I describe specific interventions integrating EMDR and IFS and more about the similarities and differences of each model. The podcast is also available on YouTube.

What would you like people outside the EMDR community to know about the use of EMDR therapy and IFS?

I want to bust the myth that both IFS and EMDR are only for people who have experienced severe trauma. IFS and EMDR are effective stand-alone modalities that can be used to treat a wide range of mental health issues, grief, loss, and life stressors, including trauma. In addition, integrating IFS into EMDR can enhance EMDR’s ability to help clients receive the benefits of EMDR while supporting clients’ connectedness with themselves and others while increasing self-compassion.

Anything else you’d like to add?

I love EMDR and IFS – these models have changed my life, and I’m excited to share ways to integrate these two models to help others.

Daphne Fatter, Ph.D. (she/her) is an EMDR Certified licensed psychologist and an EMDRIA Approved Consultant in Training (CIT). She is also IFS Certified and an IFS Clinical Consultant. She was awarded her doctorate in Counseling Psychology from The Pennsylvania State University. She completed a postdoctoral fellowship in Clinical Psychology at the Trauma Center, under the direct supervision of Dr. Bessel van der Kolk, MD. She is the former Military Sexual Trauma Coordinator at the Fort Worth Veteran Affairs Outpatient Clinic.

She is the author of “IFS and EMDR: Transforming Traumatic Memories and Providing Relational Repair with Self” in the recently published IFS book Altogether Us: Integrating the IFS Model with Key Modalities, Communities, and Trends. She provides engaging nuances on trauma treatment to international audiences from her seasoned clinical experience treating PTSD, complex trauma, combat trauma, reproductive trauma, sexual trauma, attachment trauma, grief, loss, and complicated grief. She has a private practice in Dallas, Texas.

References

Alter-Reid, K. (2023, August). Interrupting and healing trans-generational trauma with EMDR therapy [Conference session]. 2023 EMDRIA Conference, Washington D.C., August 2023.

Cloitre, M., Brewin, C. R., Bisson, J. I., Hyland, P., Karatzias, T., Lueger-Schuster, B., Maercker, A., Ropberts, N. P., & Shevlin, M. (2020). Evidence for the coherence and integrity of the complex PTSD (CPTSD) diagnosis: Response to Achterhof et al. (2019) and Ford (2020). European Journal of Psychotraumatology, 11:1739873. Open access: https://doi.org/10.1080/20008198.2020.1739873

Cloitre, M. (2020). ICD-11 complex post-traumatic stress disorder: Simplifying diagnosis in trauma populations. The British Journal of Psychiatry, 216(3), 129-131. Open access: https://doi.org/10.1192/bjp.2020.43

Cloitre, M. (2021). Complex PTSD: Assessment and treatment. European Journal of Psychotraumatology, 12(Suppl): 1866423. Open access: https://doi.org/10.1080%2F20008198.2020.1866423

Fatter, D. (2023). IFS and EMDR: Transforming traumatic memories and providing relational repair with self. In J. Riemersma & R. Schwartz (Eds.), Altogether us: Integrating the IFS model with key modalities, communities, and trends (pp. 81-110). Pivotal Press.

Haddock, S. A., Weiler, L. M., Trump, L. J., & Henry, K. L. (2017). The efficacy of internal family systems therapy in the treatment of depression among female college students: A pilot study. Journal of Marital and Family Therapy, 43(1), 131-144. https://doi.org/10.1111/jmft.12184

Hodgdon, H.G., Anderson, F. G., Southwell, E., Hrubec, W. & Schwartz R. C. (2021) Internal family systems (IFS) therapy for posttraumatic stress disorder (PTSD) among survivors of multiple childhood trauma: A pilot effectiveness study. Journal of Aggression, Maltreatment & Trauma, 31(1), 1-22. Open access: 10.1080/10926771.2021.2013375

Krauze, P. and Gomez, A. (2013). EMDR therapy and the use of internal family systems strategies with children. In C. Forgash and M. Copeley (Eds.), Healing the heart of trauma and dissociation with EMDR and ego state therapy (pp. 295-311). New York, NY: Springer Publishing Company.

O’Shea Brown, G. (2020). Internal family systems informed eye movement desensitization and reprocessing: An integrative technique for treatment of complex posttraumatic stress disorder. International Body Psychotherapy Journal, 19(2), 112-122. Open access retrieval: https://www.ibpj.org/issues.php?issueid=18

Robinson, N. S. (2023). Legacy attuned EMDR therapy: Toward a coherent narrative and resilience. In Nickerson, M. (Ed.), Cultural competence and healing culturally based trauma with EMDR therapy: Innovative strategies and protocols (2nd ed.), (pp. 383-391). New York, NY: Springer Publishing Company.

Shadick, N. A., Sowell, N. F., Frits, M. L., Hoffman, S. M., Hartz, S. A., Booth, F. D., Sweezy, M., Rogers, P. R., Dubin, R. L., Atkinson, J. C., Friedman, A. L., Augusto, F., Iannaccone, C. K., Fossel, A. H., Quinn, G., Cui, J., Losina, E. & Schwartz, R. C. (2013). A randomized controlled trial of an internal family systems-based psychotherapeutic intervention on outcomes in rheumatoid arthritis: A proof-of-concept study. The Journal of Rheumatology 40(11) 1831-1841. Open access: https://doi.org/10.3899/jrheum.121465

Sinko, A. (2017). Legacy burdens. In M. Sweezy & E. L. Ziskind (Eds.), IFS: innovations and elaborations in Internal Family Systems Therapy (pp. 164-178). Taylor and Francis.

Twombly, J. H., & Schwartz, R. C. (2008). The integration of the internal family systems model and EMDR. In C. Forgash & M. Copeley (Eds.), Healing the heart of trauma and dissociation with EMDR and ego state therapy (pp. 295–311). New York: Springer Publishing Company.

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EMDR Therapy and Internal Family Systems (IFS)