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Internal Family Systems Therapy for Addictions Manual
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 behavior of polarized, protective parts struggling to manage underlying emotional pain.
In this manual, therapists will learn 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 to their system.
An Excerpt From the IFS Therapy for Addictions:
Addictive processes affect people’s body, mind, and spirit. When people engage in compulsive, repetitive use of substances or practices like gambling, porn, high-risk sex, and over- or under-eating, it affects their physical health, reconditions their brain, and generates despair. Intimate relationships suffer, families break up, and communities fragment. Collectively, individuals who engage in addictive processes spend billions of dollars each year on alcohol, drugs, porn sites, gambling, groceries, and more. This has resulted in billions more being spent by addiction treatment centers, community mental health centers, and government systems in an attempt to address, prevent, treat, adjudicate, or incarcerate these behaviors (Hart, 2021). In psychotherapy, where do we start?
We suggest a paradigm shift. Rather than asking clients why they engage in compulsive behaviors that lead to negative consequences, we ask how these behaviors or practices help them. Rather than asking why they continue to engage in avoidant, dissociative behaviors that take them out of reality, we ask what they fear would happen if they were completely present. Rather than looking at addictive processes through the lens of mainstream treatment models, which are heavily skewed toward confronting the client and challenging their denial, we suggest engaging the client and healing attachment disruptions and other traumas that activate addictive behaviors in the first place.
When clients come to us, they are often in the grip of a short-term solution (addictive processes) to a long-term problem (disconnection and the sense of shamefulness). They feel discouraged and defeated. However, as IFS therapists, we come to this same meeting with a very different perspective. We know that all parts are deeply committed and well-intentioned. We know that compulsive parts use strategies that may have worked well for past emergencies but are much too costly in the present. We also know these parts want the client to be safe and functional. And we’re confident that the options we offer are good. Instead of participating in the chronic power struggles of protective parts, we normalize internal differences, note shared goals, and guide the client to get between parts who are in conflict and help them negotiate.
In this manual, we offer a plan for treating addictive behaviors with IFS by explaining the addictive cycle, describing a series of direct interventions that engage the client without power struggles, and providing safe, clear procedures for addressing underlying emotional pain. We include many experiential exercises and detailed case examples that apply IFS to the wide range of risky behaviors clients use to navigate stress and self-medicate pain. We intend this manual to serve IFS trained therapists who feel anxious when working with addictive processes, as well as any therapist who is comfortable treating addictions but wishes to explore new options.
IFS combines systems thinking with compassionate, inner-focused, experiential psychotherapy. It places the clinician and client on the same gentle road to healing. We know that ordinary people can be loyal, loving, and successful while also being destructive to themselves and others because they’re in the midst of an addictive process. The IFS model is tailor-made for that level of complexity.
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In the midst of an overdose epidemic, we are past due for novel approaches to working with those with substance use disorders, and Internal Family Systems Therapy for Addictions does just that. This volume provides those who might not be familiar with IFS a thorough introduction. It also offers a unique lens for both conceptualizing substance use disorders and treating them, with numerous concrete tools and practical strategies that clinicians can employ. A must-read for anyone working in addictions.
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
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.
I am deeply grateful for the arrival of Internal Family Systems Therapy for Addictions to the healthcare literature stage. It offers a real roadmap for working with the complicated, multilayered dynamics within the ‘addict’ and the people surrounding them, and it illuminates a methodology for reaching the core internal pain that has been avoided or managed until it can be contacted and healed.
The overview on addictive processes lays out with elegant clarity a thorough exploration of the addiction dynamic, a healing map, and specific, heart-led skills training and experiential exercises. The attention to the therapist role and concrete directions for addressing therapist reactivity to addictive behaviors is especially notable, as client-clinician polarities are a central challenge in addiction treatment. This book is packed with relatable human examples, all accompanied by a comprehensive treatment plan and map. Organized so that anyone can grasp the essentials and relate to the information, there are concrete tools for understanding, growth, and healing for therapists, clients, family members, members of the 12-step community, and others.
I cannot recommend this book highly enough for all who treat, relate to, or suffer from the burden of the addiction dynamic.
We all contain contradictions, yet when it comes to behaviors labeled as addictions, internal contradictions are often pathologized. Traditional treatment models confront the person seeking help and try to silence the ‘addict’ voice. Thankfully, Internal Family Systems Therapy for Addictions recognizes that the contradictions, including the seemingly destructive parts, must be recognized rather than suppressed.
After more than 20 years of experience in the field, I have found very few books that escape the misguided belief that people dependent on drugs are diseased, are in denial, should be confronted, and must get specialized ‘addiction treatment.’ This excellent and practical book challenges and rejects that view, and even questions the term addiction itself.
The authors use a logical and clear stepwise approach that does not require an expert understanding of IFS, and they include exercises for both clients and the therapist. These exercises challenge the therapist’s bias and stigmatizing ideas, replacing them with an understanding of the deep struggles that people with addictive habits desperately need to reconcile. For that reason alone, this book is essential reading for any clinician working with people who use drugs addictively.