Fostering Self-Awareness in Novice Therapists Using IFS, Mojta 2013

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Fostering Self-Awareness in Novice


Therapists Using Internal Family Systems
Therapy
a b b
Carl Mojta , Mariana K. Falconier & Angela J. Huebner
a
U.S. Department of Veterans Affairs, Readjustment Counseling
Services , DC Vet Center , Washington , District of Columbia , USA
b
Department of Human Development , Virginia Polytechnic Institute
and State University , Falls Church , Virginia , USA
Published online: 23 Dec 2013.

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To cite this article: Carl Mojta , Mariana K. Falconier & Angela J. Huebner (2014) Fostering Self-
Awareness in Novice Therapists Using Internal Family Systems Therapy, The American Journal of
Family Therapy, 42:1, 67-78, DOI: 10.1080/01926187.2013.772870

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The American Journal of Family Therapy, 42:67–78, 2014
Copyright © Taylor & Francis Group, LLC
ISSN: 0192-6187 print / 1521-0383 online
DOI: 10.1080/01926187.2013.772870

Fostering Self-Awareness in Novice Therapists


Using Internal Family Systems Therapy

CARL MOJTA
U.S. Department of Veterans Affairs, Readjustment Counseling Services, DC Vet Center,
Washington, District of Columbia, USA
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MARIANA K. FALCONIER and ANGELA J. HUEBNER


Department of Human Development, Virginia Polytechnic Institute and State University,
Falls Church, Virginia, USA

This qualitative study used a phenomenological approach to un-


derstand: (a) whether and how the Internal Family Systems (IFS)
model helps beginning therapists gain awareness of their inter-
nal processes and (b) whether and how such awareness influences
their clinical work. Semi-structured individual interviews were con-
ducted with seven beginning therapists and data were analyzed
using thematic coding. Findings suggest that IFS helped therapists
identify, understand, and manage their internal processes, which
seemed to benefit the therapeutic relationship, identify therapists’
personal agendas, model work with the internal system, and fos-
ter a better understanding of the client’s internal system. Clinical
training implications are discussed.

Research in the field of psychotherapy is clear that one of the most important
predictors of positive therapeutic outcomes is the alliance between the client
and the therapist (Lambert, 1992). According to Sprenkle, Davis and Lebow
(2009), who the therapist is as a person is a “fundamental part of the alliance”
(p. 92). Researchers suggest that relationship factors can account for as much
as 30% of therapy outcome variance, compared to the 15% contributed by
the therapist’s model or technique (Lambert, 1992). Of interest in this study is
how novice therapists can increase their self-awareness and if and how this
self-awareness influences the therapeutic alliance. Empirical research reveals
that therapists’ self-awareness is positively related to their reports of positive

Address correspondence to Mariana K. Falconier, Department of Human Development,


Virginia Polytechnic Institute and State University, 7054 Haycock Road, Suite 202C, Falls
Church, VA 22043. E-mail: [email protected]

67
68 C. Mojta et al.

feelings towards clients as well as more positive rating of the therapist by the
client (Willams & Fauth, 2005). Thus, we suggest that therapist self-awareness
is clearly one important aspect of creating a positive therapeutic alliance.
In this study, we are interested in therapists’ recognition and use of
self-awareness, how to foster this process in novice therapists and if and
how self-awareness influences their work with clients. For our purpose, self-
awareness is operationalized as the therapists’ “momentary recognition of
and attention to their immediate thoughts, emotions, physiological responses,
and behaviors during a therapy session” (p. 374, Williams & Fauth, 2005).
By this definition, self-awareness refers to the therapists’ recognition of and
attention to their internal processes of thoughts, emotions, and physiological
responses. For brevity, we will refer to these as “internal processes.”
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The concept of self-awareness is not new to the field of psychotherapy.


In psychodynamic-oriented therapies outside the field of Marriage and Fam-
ily Therapy (MFT), there has been a historic, systemic focus on the therapist’s
own emotional processes through the concept of countertransference, a term
introduced by Freud in 1910 (Kaslow, 2001). While this focus on internal pro-
cesses remained central in early MFT models (e.g., Ackerman, 1959; Baldwin
& Satir, 1987; Whitaker, Felder, & Warkentin, 1965), with few exceptions
(e.g., Bowen, 1978; Scharff & Scharff, 1997), prominent MFT models tended
to conceptualize the therapist as an outside observer of the client system,
with little regard for the therapists’ awareness of their own internal process
(Watzlawick, 1990). As Bochner (2000) argued, it seems that “the therapist’s
self was plucked out of the system and emotions he experienced were not
considered important” (p. 21).
The introduction of the second-order cybernetic perspective and post-
modern ideas in the mid-1980s among MFTs contributed to the renewed
reflection on the role of the therapist as part of, rather than outside, the ther-
apeutic system (Sparks, 2002). Even though most of the non-psychoanalytic
based MFT models continued to lack a clear conceptual articulation to under-
stand and manage the therapist’s emotional processes, the MFT field expe-
rienced an increasing agreement that a clinician “must be conscious of what
he brings into the relationship and learn to manage himself and his personal
dynamics for the welfare of the clients” (Aponte & Winter, 2000, p. 93).
Despite the agreement, most MFT programs have not clearly identified
how to formally integrate the concept of therapists’ self-awareness into their
clinical training programs (Aponte et al., 2009; Sparks, 2002). Findings from a
study on 12 of the MFT doctoral programs accredited by the U.S. Commission
on Accreditation for MFT (COAMFTE) revealed little consensus about this
aspect of clinical training in programs, suggesting that MFT training programs
do not have a clearly defined structure and methodology to help students
understand and manage their own internal processes.
The absence of specific guidelines in school curricula may stem in part
from the fact that the therapist’s internal processes are not an integral part
Novice Therapists and IFS 69

of most MFT models. In fact, one of the few programs that has a structured,
systematic way of working on the therapist’s internal processes relies on a
training approach that was developed outside the MFT models. The Person-
of-the-Therapist Training (POTT), which was created by Aponte and is being
used in the Couple and Family Therapy program at Drexel University (Aponte
et al., 2009), was designed to help therapists identify, access, judge, and
utilize the “emotions, memories, and behaviors that spring from their own
personal themes” (2009, p. 382), but it is not conceptually part of any MFT
model.
We suggest that a more recent actual MFT model of therapy designed
to address both intrapsychic and interpersonal relationships can be useful
in assisting novice therapists in increasing and managing their own self-
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awareness. Internal Family Systems (IFS) therapy model introduced in 1995


provides a coherent systemic model of therapy (Schwartz, 1995). We suggest
that IFS is particularly useful for novice therapists to learn because it provides
a simplified process for identifying and working with their own internal
processes (e.g., thoughts, emotions, physiological responses) which may
help their ability to form a therapeutic alliance.
In brief, the IFS Model of psychotherapy integrates the concepts of sys-
tems thinking with the concept of multiplicity of the mind, or “subpersonal-
ities” (Schwartz, 1995). It utilizes concepts and methods from the structural,
strategic, narrative, and Bowenian schools of family therapy in the explo-
ration of the world of subpersonalities. From the IFS perspective, a person
is comprised of an ecology of relatively discrete minds, subpersonalities
or “parts,” which together comprise an internal family. Each of these parts
establishes patterns of being (e.g., thoughts, emotions, and physiological re-
sponses). Life experiences play a major role in how the parts organize their
responses to the world. If their experiences are positive, healthy adapta-
tion will ensue; if they are negative, dysfunction may occur. In IFS, there
are two general categories of parts: exiles and protectors. Exiles are the
parts of the system that take on wounding or trauma which often includes
the negative emotions, of shame, guilt and unworthiness—usually the emo-
tions that are not tolerated by the external environment. Protectors work
to prevent the exile’s overwhelming feelings from being activated or by
shutting them down when they do occur (e.g., numbing). Parts can work
together harmoniously, or they can work against each other in a polar-
ized way. At the core of the IFS model is the assumption that the source
of healing is actually internal to the individual—not something that must
be externally provided. The model assumes a “Self” or core personality
that serves an organizing and integrative function for the entire system.
When Self is leading the internal system (i.e., the individual is “Self-Led”),
a sense of calm, compassion, curiosity, clarity etc. is manifest. Inherent to
this model is the assumption that therapists need to understand and manage
their own internal system before they can be effective in helping clients
70 C. Mojta et al.

to gain an understanding of their own (Schwartz, 1995; Timm & Blow,


1999).
How does IFS promote self-awareness? At its most basic level, IFS ther-
apy provides a structured process for fostering self-awareness through the
exploration of one’s parts (Schwartz, 1995). While a complete review of the
therapeutic process is beyond the scope of this paper, a brief overview of
the technique will be provided. This IFS process includes a series of internal
queries typical of novice therapists’ concerns in treating clients. The first is
to find and focus on a part. The query of “how does this part show up for
you?” promotes sensory awareness. My stomach gets tight and I feel nau-
seous when I know there are new clients in the waiting room. The second
query asks “How do you feel toward the part?” This question promotes a
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sense of differentiation. Thus a part of me is nauseous rather than “I am


nauseous.” I hate it—I’m so worried about throwing up that I won’t be able
to focus on what the new clients are telling me. The third query involves
getting to know what the part’s role is within the system. This part is trying
to get my attention because it’s afraid I won’t be ready to do a good job for
the new clients. In the fourth query, the part is asked about its fears. What
is this part afraid would happen if it didn’t make you nauseous? It thinks if
I’m not nauseous I won’t take the work seriously and I might miss something
important. The final query focuses on asking the part what it wants for the
entire system. It just wants me to be successful with my clients! Other IFS
techniques help the individual to work with dysfunctional (or overactive)
parts so that they become a useful rather than distracting contributor of the
system.
Given the importance of therapist self-awareness in the therapeutic pro-
cess, IFS seems to be one of the few non-psychodynamic MFT models that
conceptually links the therapeutic process and outcome to the therapist’s
own self-awareness. Given that no published empirical study has examined
whether the IFS model can actually help therapists focus on their internal
processes and whether this understanding enhances their clinical work, this
phenomenological study (Dahl & Boss, 2005) explored the experiences of
novice MFT therapists, all of whom participated in training program that
incorporated IFS as a foundational model.

METHODS
Participants and Procedure
Participation in this study was open to recent graduates (within past three
years) who had taken an elective introductory IFS course as part of an MFT
training program located in the Northeastern United States. The three-credit
highly experiential course was offered in the summer. The course objectives
were: 1) to expose students to fundamental concepts of the IFS model of
Novice Therapists and IFS 71

psychotherapy; 2) to provide opportunities for graduate-level students to


gain exposure and practice the techniques of the IFS therapy model; 3)
to provide students with a vehicle for exploring personal “triggers” when
working with clients; and 4) to provide students with an opportunity to
expand the IFS therapy model beyond the boundaries of psychotherapy and
explore application of the model to the larger system.
As part of study recruitment, the MFT program director emailed former
students with information about the study. Interested participants gave per-
mission to release their name and contact information to the main investiga-
tor of the study. The investigator followed up with each potential participant
inviting their participation via the return of the emailed Informed Consent
and a preliminary background which ensured adherence to inclusion criteria.
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In total, seven Caucasian female novice therapists agreed to participate.


Ages ranged from 25 to 63 with median age of 38 years. All participants
had taken the IFS course between 2004 and 2010. Two were still in the
MFT program while five had already graduated. Four participants had ac-
cumulated 500 clinical hours or less whereas the other three had between
1,300 and 2,500 clinical hours of training. All participants reported that they
integrated the IFS model to varying degrees into their clinical work. Four
reported using only this approach (100%), two reported using it in most of
their work (85–90%), and one indicated that she applied it only in half of her
clinical cases (50%). Four participants reported that they had also completed
additional training in IFS.
After the questionnaire and informed consent were obtained, the in-
terview was scheduled. All seven interviews were conducted by telephone
using semi-structured format. Before beginning each interview, participants
were asked if they had any questions about the study or the consent form.
The first set of the interview questions focused on whether and how the IFS
model helped participants become more aware of their internal processes
(e.g. How has the IFS model helped you become aware of your internal pro-
cesses when working with clients?). The second series of questions asked
about whether and how that awareness influenced the therapeutic process
(e.g. Could you describe a time when your awareness of your internal pro-
cesses played a role in the therapeutic process? What was different in what
you did as a result of this awareness? Did this awareness affect the relation-
ship with the client—and if so, how?).

Data Analysis
An important aspect in the phenomenological approach is the researcher’s
ability to be open to the interviewee’s experience while remaining aware
of his or her own personal biases (Dahl & Boss, 2005). Although both re-
searchers had completed the IFS Level I training—and the primary researcher
continues to receive IFS supervision, the second researcher does not practice
72 C. Mojta et al.

IFS therapy. This allowed the analysis process to be constantly monitored


for personal biases.
As part of a constant comparative data analysis method, the interviews
were transcribed verbatim and the data were analyzed to identify emerging
categories (Creswell, 2007). To ensure reliability and trustworthiness, the data
were read and re-read by the main investigator and the second investigator.
The initial codes were developed, compared and condensed into broader
themes after discussions between the two investigators. Emerging themes
were reviewed to ensure they were both internally consistent and distinct
from one another. Next, the two investigators re-read the data to (a) ensure
that the themes accurately represented the meanings presented in the data as
a whole, (b) code data that may have been overlooked in the earlier coding
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process, and (c) review the presence or absence of each theme across the
seven interviews. Following these steps, the coders discussed and confirmed
their results. Finally, the coders named and defined the themes and organized
them according to which of the areas of inquiry in the present study they
were addressing.

RESULTS AND DISCUSSION

Themes that emerged during the interviews are presented within one of the
two areas of inquiry: (1) therapist’s awareness of internal processes; and (2)
effects of this awareness on the therapeutic process. Illustrative quotes from
each of the seven interviews are included.

Awareness of Internal Processes


Overall, all the participants reported that the IFS model helped them focus
on their internal processes. Consistent with IFS conceptualizations, all par-
ticipants attributed this to the fact that IFS is a model that explicitly focuses
on both the client and therapist’s internal processes. Furthermore, some par-
ticipants expressed that they would have been unaware of their internal
processes and its involvement in the therapeutic process if they had not
studied the IFS model. In many participants’ opinion, IFS was the only MFT
model that they had studied in their graduate program that encouraged the
therapist to reflect on personal aspects and highlighted the importance of
being aware of one’s own internal processes as a therapist, especially in
comparison to Solution Focused, Structural or Narrative.

I don’t recall learning another model that helps me become self-aware. I


don’t know how I missed it, I just don’t . . . The other models like Solution
Focused, Structural, Narrative, I have not been aware of any components
of those models that direct you to be Self-reflective.
Novice Therapists and IFS 73

As the participants discussed how IFS taught them to focus on their


internal processes, many described the indicators that signaled that one or
more of their parts were becoming involved in their work. These indicators
included cognitions (e.g., distraction, unrelated thoughts), behaviors (e.g.,
fidgeting), emotions (e.g., feeling sadness), and/or physical sensations (e.g.,
nervousness, agitations). Participants’ reports suggest that IFS had taught
them not only to notice these indicators but also to view them as signaling
that one of their (the therapist’s) parts was triggered. All participants linked
the ability to attend to and understand these personal indicators with the
ability to be present and available for the client(s). This suggests that ther-
apists used their awareness of their own internal processes to inform and
guide their clinical work.
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I’ve noticed more and more lately that with practice I’ve been able to notice
tension in various parts of my body, especially around conflict, because I
tend to be very conflict avoidant. And so, I’ve definitely been able to check
in with myself . . . and notice that I was feeling tense and then checking
on what that tension is like, just noticing this is conflict and [recognizing
that]conflict can be scary for me sometimes.

I was working with a couple and they were being reactive to each other
and there was part of me that just wanted to just jump in and jump up
and down and say stop it you two, that’s enough. But I was able to hang
back, because I knew that if that part leads then it was going to end up
being – we were all going to be more reactive. So, I recognized there wasn’t
much Self energy in the room, so I had to bring it in then.

In addition to offering a framework to understand internal processes,


IFS also seems to provide therapists with a mechanism to handle and man-
age those processes. In describing what they did when noticing they were
triggered by a part, most participants used expressions such as “ask the part
to step back” and “coming back to a part.” In line with IFS’s teachings, par-
ticipants then spoke about the technique of “unblending” from a part (i.e.,
differentiating), so they could concentrate on the Self-to-part relationship.
They believed this process allowed them to be “in as much Self as possible”
with their clients while also allowing them to maintain a mindful presence
during the therapeutic process. By managing their internal processes, partic-
ipants reported that they were able to return to a Self-led position.

So there was a time when I was with a client who discussed a feeling of
being alone, and that was at a time when it hit home for me, and I felt
sad with her. And I said okay, so this is a time when I need to check in
with myself so I told the client “okay – [I want to] take just a second to be
quiet with you so that we can just feel it, because this is a really important
feeling and I’m going to be quiet with you for a minute” . . . and so there
74 C. Mojta et al.

was a part of me [emotion] that relates to this story, and so I promised [the
triggered emotional part] I would come back to it later . . . And I had it step
to the side and it was able to watch and just acknowledge that feeling
within me. I was able to allow it to step to the side while I continued the
session, and that worked beautifully.

Effects of Awareness on Therapeutic Process


Participants were asked how the awareness of their own internal processes
influences the therapeutic process. Four themes emerged: (1) enhancement
of therapeutic relationships, (2) increased awareness of personal agendas,
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(3) modeling internal awareness to clients, and (4) increased awareness of


clients’ internal processes.

ENHANCEMENT OF THERAPEUTIC RELATIONSHIP


Most participants reported their belief that when they were able to man-
age their internal processes they more quickly returned to a position of
Self-leadership which enhanced the therapeutic relationship. This finding is
consistent with Williams and Fauth’s (2005) finding that self-awareness is re-
lated to positive client ratings of the therapy process. It is also consistent with
the IFS conceptualization of Self as compassionate and curious rather than
judgmental (Schwartz, 1995). Some participants reported that when thera-
pists talked in session about working with their own internal process, the
clients’ seemed to trust them more, which also strengthened the therapeutic
relationship.

I think that [an awareness of parts] actually helped me to join with them,
me being aware of it, but also to acknowledge it in front of them, because
they obviously could see it and they could hear it in my voice. They can see
it when I get nervous and stuff; my chest gets really blotchy and my neck,
so I immediately could see it, and just acknowledging it in front of them.
Not that I was thinking ‘oh I better do this thing,’ it just came naturally,
just stepping back and taking a breath and acknowledging it in front of
them. It helped the process; whereas if I didn’t, I don’t think I would have
joined with them the way I did, and I don’t think our relationship would
have mapped it out to what it did.

PERSONAL AGENDAS
Almost all participants also linked the awareness of their internal processes
with an enhanced ability to identify when their personal agendas crept into
their clinical work. Participants described moments in the therapy session
Novice Therapists and IFS 75

where they could identify that a part of them with its own needs was lead-
ing the session preventing them from working with the clients’ needs. Con-
versely, some participants reported that when they were holding Self energy
they felt ‘in the zone’ as well as softer and lighter. According to participants’
reports, those were moments in which they did not have an agenda for the
therapeutic process, which seemed to allow the client to work at his or her
own pace and decide which parts needed to receive attention in the session.

There was a time I was working with a mother and daughter and I was
getting into this kind of repeated battle with the mother–and it happened
week after week–and it really wasn’t going anywhere. And then, through
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using IFS, I was able to find this part of me that had certain beliefs about
how she should act. And kind of this part had a big agenda for her—how
she should parent; how she should be receptive to what I am saying; and,
how I wasn’t going to let her do it her way – it had to be my way . . . this
part. So through supervision and therapy, I was able to identify that part
and kind of work with it, so it would step back and give me some space to
work [with the client].

MODELING INTERNAL AWARENESS TO CLIENTS


Participants’ experiences suggest that their explicit in-session work with their
own parts provided excellent role-modeling for clients. In particular, partic-
ipants talked about the power of being able to take responsibility for when
they were triggered and how this helped clients’ to begin to do the same.
This is consistent with Schwartz’ observation (1995) that when therapists are
working with their parts to restore a Self-led position, the most important
aspect that they are modeling for their clients is acknowledging and taking
responsibility for the interference from one of their parts.

She [wife] was like the parent and he [husband] was like the child and all
of sudden he turned it towards me and I could feel myself doing what
she was doing. So a part of me, this mothering part of me, came out and
I just started to mother him, and it’s interesting because it wasn’t until
the following week that I realized that that’s what I had done. I actually
realized after that session but it was a week later when I was able to let him
know that I realized that I did that. And you know, “I realized I felt like I
got into that mothering position with you, and I just want to apologize;”
I didn’t catch it at the moment, and I’m catching it now and it was kind
of like modeling that too where you can make a mistake and you know
you can come back later . . . If I can take responsibility for what I do in the
session again and it gives him a model – an opportunity – to do that and
I think I also helped the wife to see what that looked like – somebody was
mothering him.
76 C. Mojta et al.

INCREASED AWARENESS OF CLIENTS’ INTERNAL PROCESSES


Most participants reported that they thought that the work they did with
themselves in identifying and understanding their own internal system en-
hanced their ability to understand their clients’. For example, this knowl-
edge about themselves helped them more readily understand moments when
clients were blended with a part(s).

It [awareness of own parts] makes me much more aware of the parts of my


clients . . . and when they surface, especially the polarity going on. I don’t
think that I would have recognized any of that if it hadn’t been for the
work that I have done with my own parts.
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Clinical Training Implications


The findings that emerged support the notion that the therapists’ ability to
understand and work with their own internal processes has significant effects
on the clinical work with clients (Aponte et al., 2009; Cheon & Murphy, 2007;
Timm & Blow, 1999; Watson, 1993). The connection between the therapists’
internal processes and the therapeutic work reaffirms the need that has been
voiced by many contemporary professionals, educators and researchers in
the field that MFT therapists have to be trained to attend, to understand, and
to manage their internal processes (e.g., Cheon & Murphy, 2007; Deacon,
1996; Lum, 20002; Watson, 1993). In a field that has developed few MFT
models that can help therapists understand and deal with their own internal
processes, the findings from the present study suggest that this might be one
of the valuable contributions that IFS can make to the MFT field. This seems
particularly relevant at a time when the MFT field seems to be in need of
more systematic training on the use of self in academic programs (Aponte
et al., 2009, Timm & Blow, 1999).

CONCLUSION

In summary, participants in this study reported that their awareness, under-


standing, and successful management of their own internal system seemed
to have beneficial effects on their clinical work with clients. These effects
included strengthening the therapeutic relationship, identifying the thera-
pist’s personal agenda, modeling for clients how to work with their internal
system, and enhancing the therapist’s understanding of the client’s inter-
nal system. These findings provide preliminary empirical support to the IFS
model’s principle that in order to help clients work with their own internal
system, therapists need to be aware of, understand, and manage their own
internal processes (Schwartz, 1995).
Novice Therapists and IFS 77

Unlike most MFT models that concentrated on observable interactions


and behaviors in clients, IFS was developed as a model that focuses on
the individual’s internal system. The findings from the present study are
consistent with IFS conceptualizations and suggest that one of the strengths
of IFS lies in its ability to help beginning therapists focus, understand, and
manage their own internal system with a theoretical model that can also use
to guide the clinical work with clients. This strength is important not only
because of the clinical benefits reported in this study but because it positions
IFS as one of the few non-psychodynamic MFT models that has such strength
at a moment in which the MFT field is focusing on how to train therapists
more systematically to become aware of their internal processes and their
influence in the clinical work.
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