Manual Parts 14 Clinical Applications Ifs

Rehab Kids
2-Day Advanced
Workshop
Clinical Applications of Internal
Family Systems (IFS)
Frank Guastella Anderson, MD
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2-Day Advanced
Workshop
Clinical Applications of Internal
Family Systems (IFS)
Frank Guastella Anderson, MD
Rehab Kids
ZNM055925
3/20
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58pp
3/20
Rehab Kids
MATERIALS PROVIDED BY
Frank Guastella Anderson, MD, completed his residency and was

a clinical instructor in psychiatry at Harvard Medical School. He
is both a psychiatrist and psychotherapist. He specializes in the
treatment of trauma and dissociation and is passionate about
teaching brain-based psychotherapy and integrating current
neuroscience knowledge with the IFS model of therapy.
Dr. Anderson is a lead trainer at the Center for Self Leadership

with Richard Schwartz, PhD, and maintains a long affiliation
with, and teaches for, Bessel van der Kolk’s Trauma Center at
Justice Resource Center in Boston, MA.
Dr. Anderson has lectured extensively on the Neurobiology

of PTSD and Dissociation and co-authored the Internal
Family Systems Skills Training Manual (PESI, 2017). He wrote
the chapter “’Who’s Taking What’ Connecting Neuroscience,
Psychopharmacology and Internal Family Systems for Trauma”
in Internal Family Systems Therapy: New Dimensions. (Routledge,
2013) and co-authored the chapter “What IFS Brings to Trauma
Treatment” in Innovations and Elaborations in Internal Family
Systems Therapy (Routledge, 2016).
He also maintains a private practice in Concord, MA, and

serves as an advisor to the International Association of Trauma
Professionals (IATP).
Speaker Disclosure:
Financial: Frank Anderson maintains a private practice. He receives a consulting fee from the
Center for Self Leadership. Dr. Anderson receives a speaking honorarium from PESI, Inc.
Non-financial: Frank Anderson is the President of the Foundation for Self Leadership.
Materials that are included in this course may include interventions and modalities that are beyond the
authorized practice of mental health professionals. As a licensed professional, you are responsible for
reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of
practice in accordance with and in compliance with your professions standards.
Two Day Clinical Applications
Workshop:
Internal Family Systems (IFS)
1 Therapy
Frank Anderson, MD
Website = FrankAndersonMD.com
@2019 Frank G. Anderson MD, all rights reserved
2
Meditation
1
3
Experiential Treatments
 Clients have the resources to heal

 Emotions and Body are central
 Relationships- a core component of healing
 Separation is a necessary component
 Nothing therapeutic happens in re-experiencing
4 Some Experiential Treatments
 IFS: Go inside, find & feel the part, hear directly

from all concerned parts
 AEDP: Tracks moment-to-moment emotional
experience & the body, prioritizes dyadic
relationship
 EMDR: Clients self-heal, affect & body are
central, therapist stance is neutral
 SP/SE: Bottom-up body-focused therapy,
addresses implicit memories, prioritizes
therapeutic relationship
2
5
What’s Important for Healing
Mindful Separation
(Unblending)
Self vs. Building Resources
Permission vs. Stabilization
Therapeutic Relationship (TR)
Healing at the Core
6 Internal Family Systems (IFS): Model Overview

 Roots
 Systems Thinking
 The Goal is integration
 Multiplicity of the Mind
 “We all have Multiple personalities”
 Assumptions
 ALL parts are welcome
 They ALL have good intentions
 Look at “intent not effect” of parts
 Parts can carry burdens or take on protective roles
 We all have Self energy- it does not need to be cultivated or created
 We were born with it.
3
7 The Goals of IFS
 Permanent healing of emotional wounds
 Releasing parts from their extreme roles
 Restoring parts’ trust in Self-leadership
 Helping parts integrate back into the

system
 Contraindications- currently in an abusive

or unsafe environment
Video
8
“All the little voices in our heads”
4
9 Vulnerability Turned Into Wounds
 To be who we truly are, to feel our emotions and to be able to
share it with someone else.
 Brene’Brown
 “To feel is to be vulnerable.”
 “Vulnerability is the core of all emotions and feelings.”
 “Vulnerability is the birthplace of love, belonging, joy,
courage, empathy and creativity.”
 “Uncertainty, risk and emotional exposure.”
 When we are vulnerable with someone and they react from their
parts with criticism, attack, rage, violation, defensiveness or
neglect.
 It can turn into a wound and then we need to protect ourselves.
10 Parts That Develop From Being Hurt

 They all have a role in the system.
 To protect or hold wounds
 They interact with each other & the world
 Learn to “speak for” “not from” your part (Blended)
 3 Kinds of Parts
 Parts that carry wounds (exiles)
 Parts that prevent wounds from getting triggered (manager)
 Parts that stop the pain (firefighters)
 We also have parts that are normal aspects of our personality

10
5
11 Wounded or Burdened Parts
 Often young & vulnerable
 Carry wounds, burdens, hurt & trauma
Memories, sensations, emotions and beliefs
Shame, unmet needs, lack of connection, being
alone
 Stuck in the past, implicit memory
 “Parts are not their wounds”
 Creative, sensitive, loving & playful without burdens
11
12 Protective Parts
Trying to protect us from being hurt again

Keep wounds exiled
Therapists have them too!
Countertransference redefined
Taking responsibility for your parts
2 kinds of protectors parts

Prevent the pain (manager)
Stop the pain (firefighter)
12
6
13 Prevent the Pain
Try to prevent the wounds from being

triggered
Parts that run day-to-day life
Examples
Being perfect, being in control,
trying to please, wanting to be
liked, caretaking, avoiding
conflict, obsessing, wanting to
look good.
13
14 Working with Preventive Parts

(Managers)
 These parts are hard working, heroic, ever present and
overworked.
 They tend to run our day-to-day life.
 They are exhausted and love taking medications.
 They are tenacious and often think they are the Self.
 “I am John”
 Can take a long time to get their permission.
 They are afraid of reactive parts and feel like a failure when
reactive parts show up.
14
7
Get to Know One of Your
15
Preventive Parts Exercise
The caretaker, the fixer, the one that understands, the one that
accommodates, the one that figures things out, the funny one?
15
16 Stop the Pain

React only when the wound has been
activated!
Try to “put out the fire”
Extreme in their response
Culture and society are not a fan.
Examples
Binging, purging, cutting, suicidal
thoughts, substance abuse, numbing
out, dissociating
16
8
Suicidal Part
Systems
17 Drinking Part
Extreme Parts Out Of Here Part
Thinking Part
Pleasing Part Parts Involved in

Daily Life
Funny Part
Exile Carrying Feeling unloved

Wounds
17
18 Self
Different from parts
Healing capacity
Soul or core
Spiritual space for some
“A state of being”

18
9
19 Qualities of Self (8 C’s)
Curious Courage
Calm Creative
Confident Connected
Compassion Clarity
19
20 ReSource Project (Tania Singer)

 Compassion
 Feeling of concern for others suffering with motivation to
help
 Care-seeking network
 Ventral striatum, pregenual anterior cingulate cortex and
medial orbitofrontal cortex.
 Unblended
 Empathy
 Resonate with others suffering
 Interoceptive- feel others pain, can lead to burn out
 Anterior insula and anterior midcingulate cortex
 Blended (when our exiles are activated)
20
10
21
Compassion- Empathy Exercise
21
22 Self of the Therapist, Self of the Client
 Ideally looking for the therapist and the client to be in Self

 Parts need empathy and compassion from the therapist
 Parts also need empathy and compassion from the client
 Accessing Self Energy Meditation

 Empathy and Compassion responses
22
11
The Steps of the Model:
23
Working with Protective Parts
23
24 Starting an IFS Session
Listen to the range of parts

Name the parts you hear
Have the client go inside and pick a
“target part”
Work with the various parts that jump in
Ask them to relax, step back or give some
space
If they refuse, they become the new target
part
24
12
“The goal of working with
protective parts is to help them
separate from the Self, to learn
their job and fear and to get their
25 permission to access the wound.”
25
26 The 6 F’s Working with Protective Parts
1. Find the Part

2. Focus On It
3. Flesh it Out
4. Feel Toward It
5. Be Friend It
6. What Is It’s Fear
26
13
27 The First 3 F’s
Identifying the Target Part and Unblending
 1. Find the Part- Where is it located in or around your
body?
Identifying a neural network
 2. Focus On It- Going inside
Getting the client used to internal focus
 3. Flesh it Out- Get to know more about it
How do you know it? Hear it? See it? Feel It?
Does it have a color, shape
27
28
Identifying Parts Video (1)
28
14
Feel toward & Flesh out
29
Video (2)
29
30 The 4th F
Unblending and Identifying Self
4. Feel Toward It- Self Energy detector
The most important question here.
Parts are capable of stepping back.
Neuroscience talks about “state change”
When parts are willing to step back Self
emerges.
Difficult to achieve in Trauma
30
15
31
Real Self Energy Video
31
32
Practice First 4 Steps
32
16
33 The 5th F- Be-Friending
Learn Its Job and Positive Intention
Internal Attachment work
Fostering the relationship between the Self and
the protective part
A two way street
Have the part share what it is holding
What is its job
Learn about its positive intention.
33
34 The 6th F
Find Out Its Fear
What are you afraid would happen if you didn’t

do this job anymore?
Reveals the wound or a polarization (conflict)
“I’m afraid she will be all alone.”
“I’m afraid she will start drinking again.”
Most protective parts are organized around
Fear.
34
17
35 Common Protector Fears
Overwhelm/ the pain is too much.

The secret will be out
They will loose their job
Other parts will be triggered
They will be judged
Self/Therapist can’t handle the pain
Can’t handle the change
35
36 Summary- The Goal of Working with Protectors
Identify a target part

We help the part separate (unblend)
We help the client access Self
energy
We learn about the parts job & fear
36
18
37
Practice/Demo all 6 Steps
37
38 Working with Protectors- The 6 F’s

1. Find the Part- Where is it located in or
around your body?
2. Focus On It- Go inside
3. Flesh it Out- Get to know more about it.
4. Feel Toward It- Self Energy detector
5. Be Friend It- Relationship building, internal
(Self to part) and external (Part to therapist)
6. What Is It’s Fear:
“What are you afraid would happen if…”
38
19
The Science Behind the 6 F’s
39
39
40
Mind-Brain Relationship (Siegel)
 Function vs. Structure

 Mind-
Embodied, Relational & Self-organizing process
that regulates the flow of energy & information
Mind deals with energy
Attention (PFC) directs energy flow
The Mind can change the Brain
 Brain
Is structure and can change states
 Not all agree
40
20
41 Neurons to Networks
 Human brain has 85 billion neurons, 100 trillion

synapses and 100 chemical neurotransmitters
 Neurons meet at synapses and communicate across

the gap via neurotransmitters
 These connections form neuronal circuits or networks

Activation of these circuits in different parts of the
brain give rise to thoughts, emotions & actions
41
42 The Brain Changes
 Neurons fire when we have experience.

 Firing strengthens and grows new synapses.
Neuroplasticity
 Firing also grows new nerve cells.
Neurogenesis
 When the system is working together smoothly
Neural Integration = Mental Health
Imagination is a powerful neuroplastic agent
42
21
Horizontal (right-left) Network
43
Left Right
Hemisphere Hemisphere
Linguistic, Physical,
Logical, Emotional
Factual, Unconscious
Conscious
Connects to
Connects to
Hippocampus
Limbic,
Brainstem &
Body
43
Vertical Network
44
Medial Prefrontal
Cortex,
Top-Down Anterior
Cingulate
& Insula
Right
Hemisphere
Limbic
(amygdala,
hippocampus,
hypothalamus)
Brainstem &
Thalamus
Body
Bottom-Up
44
22
45 Networks of Emotions (Panksepp)
 Networks of seven basic emotional systems
 Seeking- explore, desire, aspirations of the heart
 Mesolimbic dopamine system
 Fear/Anxiety-including fight & flight
 Fight= high dopamine Flight= low dopamine
 Rage/Anger
 Closely parallels fear system, different paths in amygdala and beyond
 Lust/sexual
 Female- (oxytocin), Male- (vasopressin)
 Care/Nurturance
 Oxytocin & prolactin
 Panic/Grief-Separation & loss can lead to panic attacks and depression
 Opioids, oxytocin, prolactin
 Play-most underutilized emotion in therapy
45
46
Symptoms = Mind & Brain = Parts
90% of input to cortex comes from

internal processes. We scan for
examples that prove pre-existing
beliefs. This is driven by fear to avoid
danger. (Cosolino)
Speculation- “Parts live in the mind

and utilize neural networks in the
brain to express themselves.”
46
23
47 How We Pay Attention: Going Inside
Exteroceptive attention
 Externally focused, relies on prefrontal cortex
Interoceptive attention
 Internally focused, relies on insula and posterior cingulate
which are linked to limbic system & brainstem
 (emotions and physical sensations)
 Our internal attention has greater influence on our

sense of happiness
47
48 Meditation: An Important Tool in IFS for

Accessing Self Energy
- John Kabat-Zinn- back pain study (MBSR)

Uncoupling of thoughts & symptoms from self
(Unblending or Accessing Self Energy)
Study experienced meditators frontal lobe &

 parietal lobe activity-shift from outer to inner
attention (Manson)
48
24
49 Self Energy
Speculation- Self Energy is a “state of being”
that lives in the mind and utilizes integrated
neural networks in the brain. It is both internally
and externally connected to the flow of energy
and is a maximally integrated state.
Speculation- Actually the lack of neural network
firing?
The dimensions of Self.
49
50 Normal Response to Fear
 Here we are dealing with/processing thoughts

feelings and body sensations.
 Normal activation with normal response and

recovery.
 Keeping thoughts feelings and physical

sensations from getting out of control.
50
25
The Vertical Network and Fear (extinction)
51
(Ledoux)
OMPFC
AC
(LA)
NE, 5HT, DA
(CE)
Thalamus Amygdala
Hypothalamus
Hippocampus
Brainstem
Sensory ANS,
@2019 Frank G. Anderson MD, all rights reserved endocrine
51
52
Beyond the 6 F’s
 Direct Access
When separation is not possible
 Updating the Part
Introducing the part back then to the Self of
today
 Deal with Overwhelm
IFS not phase oriented treatment
 The Invitation
What if you didn’t have to do this job anymore
What if we could heal the wound
52
26
53 When Separation is Not Possible
Talk Directly to the Part-Direct Access
 Direct access- When the part won’t unblend
 Can I talk to the part directly.
 Are you there?
 So you are the part of …. Who……?
 What are you afraid would happen if you separate?
 What other concerns do you hold?
 After addressing all the fears, Can I talk to ……Now?
 Did you hear all of what that part just said?, if not make
sure you share it.
 Goal of Direct Access is…

@2018 Frank G. Anderson MD. All rights reserved
53
54 Introducing the Part to the Self

 Updating the System
 Parts usually know the Self from the time of the trauma
 Internal Attachment Work
 Develop a trusting relationship between the Self & Part
 We are repairing a rupture
 Watch for caretaking parts in the therapist
 Updating the System
 Parts usually know the Self from the time of the trauma
 How old do you think John is ?
 Listen to the first thing that comes up, don’t filter.
 Can you get to know the John of today, his core, not a part?
54
27
55 Dealing with the Overwhelm
The most common issue with Trauma

Get the guarantee before proceeding
Practice and have parts watch
We want to hear about all of it , just a bit at a
time.
Nothing therapeutic happens with reliving.
55
56 Getting Permission to Access the Wound

 You are the boss
 I totally get why you need to do this
 The Invitation
 What if you didn’t need to do this job anymore
 What would you rather do?
 What if we could help with the overwhelm
 What if we could heal the pain
 Offer hope for a new vision
 Watch your own parts!
 Staying clear and confident
56
28
Video- Putting it all together
57 Direct Access, Learning It’s Job
and Fear and Getting Permission
57
58 Summary- The Goal of Working with Protectors

We identify the target part
We help the part separate (unblend)
We help access Self energy
We introduce the Part to the Self
We foster the internal relationship
We Learn about its job and fear
We address protector fears and deal with
overwhelm
We offer the invitation and get its permission
to heal the wound.
58
29
Practice Direct Access and
59
Addressing Protector Fears
59
60
Polarizations and Alliances
60
30
61 Polarizations or Conflicts
 A common protector fear is another protector
If he stops drinking he will get depressed
 Parts in conflict block access to wounds
 Often protecting the same wound
But not always
Helpful for parts to see they have a common goal
 Commonly confuse the therapist and block progress
That’s the point!
Common in DID
61
62 The Solution to Polarizations

 Best to have the Self hear from both parts
Not necessary for parts talking to each other
When each side feels heard by the Self,
 It fosters trust in Self
They see that they have the same goal, (to protect
the wound), but they do it in a different way
 Self usually come up with a solution to the problem
Not the therapist
62
31
63 Alliances Between Parts
 Parts can also work together to protect

 When one part fails to do its job, another part takes over
to help protect
Often Managers and Firefighters
 Learning about alliances helps you get to know how the
system works
63
Wounds
64
(Exiles)
64
32
65 Wounded parts
When vulnerability goes wrong

We sense them but they are often hidden or
under the surface
They drive most decisions in our clients life
They gets us and others to rescue and caretake
them
Often young but not always
65
How IFS Handles Healing:

The Unburdening Process
66
66
33
67
Unburdening
After all protective parts have given

access/permission.
In the presence of Self Energy
(Client & Therapist)
Have clients Self be in connection with the
exile or wounded part
67
68 The Steps of Unburdening

Witness- What they want you to know or
see
Re-do/Retrieval- Go in the scene and
get them out
Be with them in the way they needed
someone to.
Unload- Feelings, Thoughts & Beliefs
The elements (wind, fire, rain…)
Enter New Qualities
Have Protectors take a Look Now
68
34
69 The Post Unburdening Process
Check in daily for about 3-4 weeks

Permanent healing, reinforce networks?
Follow-up with protectors to see how they

are doing in their new roles and if they
have additional work to do.
Awareness of new way of being in the

world
69
70 Integration & Repair

Backlash
Parts didn’t give permission, not OK to feel
good, protectors not followed up with.
Why Burdens return
Not the whole story, not fully witnessed, no
client follow-up, other parts are using the
burden, something traumatic happened in life
Repair & Forgiveness
Self to parts & Self to perpetrator
70
35
71 Legacy Burdens
 We all carry Legacy burdens
 Culture, gender, ethnic, race
 The gifts and the burdens of legacy
 They often block healing in trauma
 Can be unloaded without witnessing
 Sometimes they hold messages they want to share
 Check the % that belongs to the client and the % that is not theirs
and can be released
 Bring in all ancestors that have carried the burden
 Release and transform for all involved
 Address loyalty issues
 We each have our own paths
 Call in the Self of the parent
71
72 Epigenetics or Legacy Burdens

Epigenetic transmission of PTSD (Yehuda)
Methyl groups (CH3) attach to genes & affect
which ones will be transcribed into proteins
Mothers with PTSD- methylation of NR3C1-1F
Treat with 30 mg of cortisol?
Fathers FKPB5 gene (preconception)
Post natal changes of licking & grooming in
animals change methylation (environment)
37 different genes identified with PTSD so far
72
36
73
Sit in Silence Exercise
73
The Science Behind Emotional Healing
74
74
37
75 Memory Reconsolidation
 The only form of neuroplasticity capable of

unlocking synapses in existing emotional memory
 Does not affect autobiographical memory, still

remember event & fear, but no feelings are re-
evoked.
 Different from Counteractive change- here new

networks are formed in addition to old ones,
competition to override old, but it still remains.
75
76
Memory Reconsolidation (Ecker)
 Accessing phase- Identification of specific symptom &
retrieval of implicit awareness
 (Find, Focus, Feel)
 Reactivation- activating implicit memory renders it

susceptible to being unlocked or in a destabilized state,
(Witnessing parts story, not re-experiencing)
 Mismatch- a full contradiction or disconfirmation of target

memory, critical step
 (when part feels self really “gets it”),
 Unlocks synapses for up to 5 hours
 Erasure- revise the memory with new learning

 (retrieval, giving part what it wanted & entering new qualities)
76
38
77
Demo
77
78
IFS Applications
78
39
79
Psychology vs. Biology
(Part vs. Symptom)
 Real Mind Body Medicine

 Differentiate a Therapeutic Issue (Part) from a Biological
Process (Symptom)
 When we think “symptoms” we think “diagnoses” or
biological processes:
 Parts can help differentiate the two.
 The part that holds the trauma, the part that is
vigilant, the part that is afraid to go to sleep etc.
 We treat with therapy.
 When biology overtakes parts.
79
80 Depression and Anxiety

 Depression
 Depression is not a feeling
 Differentiate emotions (sadness) from a biological syndrome
 One part or several different parts
 The part that is sad (exile)
 The part that runs away from sadness with substances, food, work and causes a depression
 % that is biological or genetic and % that is emotional and therapy worthy
 Anxiety
 Part that worries. What are you afraid of?
 Differentiate anxiety from panic
 Different neural networks
 Or are the serotonin levels low?
 Who is the exile?
80
40
MAPS: Multidisciplinary Association for Psychedelics
81
Studies
 MDMA- next slide
 LSD- decrease anxiety, discovery of serotonin
neurotransmitter
 Psilocybin- mushrooms, serotonin hallucinogen
 Ibogaine- People with problem substance use have
found ibogaine can significantly reduce withdrawal from
opiates and temporarily eliminate substance-related
cravings.
 Ayahuasca- for drug addiction and PTSD
 Medical Marijuana- PTSD in veterans
@2019 Frank Anderson MD. All rights reserved.
81
MDMA Assisted Psychotherapy

82
MDMA
 5-HT, NE, DA, oxytocin & vasopressin,  Left
amygdala activity,  PFC activity
allowed patients to re-experience traumatic
experiences in the absence of fear (enhance
extinction)
 The combined neurobiological effects of MDMA can increase

compassion for self and others, reduce defenses and fear of
emotional injury, and make unpleasant memories less disturbing
while enhancing communication and capacity for introspection
@2019 Frank Anderson MD. All rights reserved.
82
41
83 OCD and ADHD
 Explore the parts that develop as a result of biology

 Again differentiate biology from emotional
Parts that distract, parts that disconnect, parts that
obsess and worry
Parts that deny or avoid dealing with the reality of the
struggle
Parts that feel inadequate, insecure, defective or less
than (wounds)
83
84 Psychosis and Bipolar Disorder
 Dysregulated parts and distorted thinking in Trauma

 Combination of distorted beliefs and dysregulation, hyper
or hypo-aroused with Trauma
 Can recover with validation, support and compassion
(unblending)
 Biologically based thought disorder
 Working with Psychotic parts
 Empathic confrontation (Self lead)
 Can trigger shame and disempowerment in parts
 Tricky when both are present
 Bipolar and Trauma
 Containment and structure with freedom and choice
84
42
85 Autism Spectrum Disorders
 Rigid-concrete thinking
 Anxiety
 Avoidance
 Fantasy
 Stimming
 OCD symptoms
 Inertia
All Protective parts help manage fear, overwhelm,

excess empathy and a sensitive nervous system
85
86 Substances and Addictions
 The Goals in IFS with regard to addictions is not to stop

the substance use
 It is to heal the wound the addictive part is trying to
protect, so it no longer has to do that job
 We trust the positive intention of all addictive parts
 We offer them hope (the invitation)
What if you didn’t have to do this job anymore
What if the wound was no longer there
86
43
87 Often more that one Addictive Part
 The part that drinks to feel comfortably numb
 Keeping things at bay
 The part that says “I’m out of here.” and drinks shots
 The part that drinks to feel socially comfortable
 The part that eats to sooth

 The part that eats for “fuel and energy”
 The part that eats to fill the emptiness inside.
 That part that smokes pot to get away from feeling bad about not being
able to focus and concentrate in school
 That part that smokes pot to be cool
 The part that smoke pot to forget about being bullied
87
88 Befriend Addictive Parts

 The parts can protect the same wound or different wounds
 They know they are ineffective at their job and they want help.
 They don’t necessarily want to use the substance, but they feel
they have to. They feel that they don’t have another option
 “I really like what it feels like when we don’t drink, we’re clear,
we get things done, our wife is much nicer to us.
 When discussing the negative effects of addictive parts, shame
almost always gets activated
 The shamed
 The shamer
 Shamers can hold guilt and remorse for their behavior
 The part that runs away from the shame
88
44
89 Substance use and Addictions
 Similar approach with Eating issues
 Often restriction and binging parts in conflict
 Most of the day can be spent thinking about food
 Food as control
 Accessing the wound is challenging
 Sexual addiction
 Parts draw to them self the very thing they are trying to
protect from
 Avoidance and attention
 Gambling
 Technology overuse
89
90 Beyond Healing with Addictions

 After the wound is healed, things don’t magically disappear.
 Need to address the biology of the substance
 Set up a safe taper schedule
 Everyone needs to agree inside
 Need to address the habit (Behavior)
 This is what we do after dinner, this is what we are used to.
 A new way of being in the world, establish new habits.
 Need to address the environment they are living in
90
45
91 Shame
Critical or Neglect
 Shame
Parts that shame
Critical-shaming protectors
Feel guilt for what they do
Parts that have been shamed
Exiles- I’m no good
Parts that run away from and
perpetuate the shame
Parts that feel shame as a result of
neglect (no one cares, I’m no good)
91
92 External Critic
"Shamer”
Internal Critic
"Shamer"
Substance Using Pleasing,

“Out Of Here Parts”
Parts Perfect, Trying to
(If it gets bad enough)
(Trying to sooth) Fix the Problem
Exiled Part
(Unlovable)
“Shamed”
@2019 Frank G. Anderson MD, all rights reserved Arrow demonstrates how
parts feel bad about their
own behavior
92
46
External Neglect
93 "Shamer”
Internalized Neglect
(Disconnects to protect)
Intellectual Parts
Perfectionistic, “Out Of Here Parts”
(Tries to fill the void)
Angry Parts (What’s the point?)
(Blocks feelings)
Exiled Part
Feelings are (Unlovable) Arrow demonstrates how
difficult to access “Shamed” parts feel bad about their
own behavior
93
94
Grief
Traumatic for clients with have relational trauma

histories
What is worth holding on to what are you able
to let go of?
Many parts have many reactions to the loss
Takes time, happens in layers
What is normal grief? What is connected to a
past wound (loss and attachment)
94
47
95 Working with Couples
 Toni Herbine Blank
 She is hysterical. He is on the spectrum
 Blame and Shame are common
 Attraction and Redemption
 We are drawn to people with similar emotional development and similar
wounds.
 We silently contract to heal each other’s
 Tracking the Sequence
 The offer is healing the wound, so his or her behavior no longer
bothers you
 Relational Unburdening
 Empathy and Compassion from both the Self of the client and
their partner.
95
96 Tracking the Sequence

Begin a “u” turn
What happens inside you?
What do you hear yourself saying to yourself?
What is your first impulse?
What action do you take?
What do you do or say in relationship to him or her?
96
48
97
Tracking the Sequence Demo
97
98
Kids and Attachment
98
49
99 Attachment Theory
 The quality of parental care within the first two years of life
promotes an attachment style for a child and sets a
template for future relationships in adulthood.
 These early bonding experiences are later remembered
not as visual or verbal narratives but in the form of
“implicit” or “emotional memories.”
 This sets the stage for affect tolerance, self soothing and
an integrated sense of self later in life.
 Healthy regulation by primary caregiver leads to healthy
self- regulation and secure attachment.
99
100
Attachment Theory
 Attachment Styles
 Secure (62%)
 Healthy regulation by primary caregiver leads to healthy self- regulation
and secure attachment.
 Avoidant (15%)
 One response to an unresponsive or rejecting caregiver
 Anxious-(Ambivalent) (9%)
 The other response to unresponsive or rejecting caregiver
 Disorganized (15%)
 When caregivers are frightening (hostile/intrusive or helpless/fearful)
 Seek connection & avoid the caregiver. Fright without solution!
100
50
101 Attachment Trauma
Different parts of children attach to different parts of the care-
giver
This can create attachment wounds
Attachment wounds make most of our relational
decisions
Healing involves Internal Attachment with Self
External vs. internal relationship as therapeutic?
Therapist as an adjunct- The Self as the primary
 What are we offering in IFS?
Self as the corrective experience not the therapeutic
relationship
101
102 Working with Kids
 Lisa Spiegel
 Parts are an easy sell to kids, not so much for
teenagers
 Play therapy is externalizing parts (unblending)
 Can prevent exile development when bringing forth
Self into an acute trauma
The parents, the therapists and child's
 Modeling is the most effective way to incorporate
parts language into the family
102
51
103 Parenting and IFS
 Parent Coaching
 Working with triggers within parents
 Help them heal their wounds
 Kids behavior is primitive and normal can mimic abusive
behavior for parents
 Parents stop kids behavior to not get triggered internally, this
creates exiles in our kids
 The triggering agreement (Co-parenting),
 The Parent Self is different from Self Energy
 Love, Limits and Teaching
103
104 LGBTQ Population

 New world today,
 Gender and Sexual fluidity
 Queer, Pan, Bi, pronouns
 Process internally is still the same
 Trans clients
 Staying with their process and their time-frame
 Helping clients connect with Self
 Dealing with shame, fear, truth internally as well as externally
 Dealing with cultural, societal, family burdens
104
52
105 Groups & Inpatients
 Rheumatoid Arthritis Study
 Limited time, limited amount of work to be done
 Primary focus on protectors
 Extreme parts typically bring people into hospital
Learn about their positive intention
 Managers who run day to day life are overtaken
Deal with their shame about failing
 Help restore the balance within the system
 Long term groups can progress to healing
 Create environment for healing & witnessing to happen in a safe manner
105
106 Spirituality
Guides
Angels
Departed Loved ones
God, Buddha, Jesus
Be open to what shows up in your clients, have
your parts step back
106
53
107 The Various Types of Trauma
Acute or single incident trauma

PTSD or chronic trauma
Complex or relational trauma
Developmental trauma
Extreme or Dissociative Identity Disorder (DID)
107
108 Extreme Parts
These parts scare therapist’s

Most often activate our own parts
Often hard to embrace their positive
intention
Will block progress unless they are truly
appreciated and understood
108
54
Therapist’s Parts
109
What get’s activated in you?
Experiential exercise
109
The Autonomic Nervous System (ANS)

Sympathetic
Fight or flight
Activation
Hyper-arousal both physically and emotionally
Parasympathetic
Rest and Digest
Withdrawal or Blunting or Hypo-arousal
110 Ventral and Dorsal Branches
Three Categories of Extreme Reactions

1. Activation or Hyper-aroused
2. Blunted or Hypo-aroused
3. Wounds
110
55
111 Fear-PTSD- Hyper-Aroused (Ledoux)
OMPFC
AC
(PAG)-freeze
(LA)
(BLC) High NE, DA
Low 5HT
Thalamus
Amygdala High Glutamate
Hypothalamus
Hippocampus
Brainstem
Sensory ANS,
@2019 Frank G. Anderson MD, all rights reserved endocrine
111
112 Connection vs. Danger

Social Engagement System- Poly Vagal Theory
(Porges)
Feedback to brain regulating arousal during
connection
Face to face contact (eyes), lungs, heart, throat
“Smart Vagus”- ventral portion of the parasympathetic
Contact without fear, engagement/disengagement, safety
Life threat= dorsal branch parasympathetic

Shuts down PFC, amygdala, hippocampus, brainstem
112
56
113 Extreme Parts- Hyper or Hypo-Aroused
(Lanius) imaging studies, chronic child abuse
Hyper-aroused, Hypo-aroused,
reactive, withdrawal,
sympathetic dissociate
Low activation High activation

mPFC & AC, mPFC & AC,
High insula Low insula
Failed inhibition Over inhibition,

Low emotion,
High emotion
Body numbing,
High sensation Blunting
113
Video
114
Suicidal Part
114
57
115
Thank you
Frank Anderson
www.FrankAndersonMD.com
115
58
NOTES
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Rehab Kids

www.pesi.com/blog | www.pesirehab.com/blog | www.pesihealthcare.com/blog | https://kids.pesi.com/blog

Printed in the United States

Frank Guastella Anderson, MD, completed his residency and was

Dr. Anderson is a lead trainer at the Center for Self Leadership

Dr. Anderson has lectured extensively on the Neurobiology

He also maintains a private practice in Concord, MA, and

@2019 Frank G. Anderson MD, all rights reserved

 Clients have the resources to heal

@2019 Frank G. Anderson MD, all rights reserved

4 Some Experiential Treatments

 IFS: Go inside, find & feel the part, hear directly

6 Internal Family Systems (IFS): Model Overview

@2019 Frank G. Anderson MD, all rights reserved

 Releasing parts from their extreme roles

 Restoring parts’ trust in Self-leadership

 Helping parts integrate back into the

 Contraindications- currently in an abusive

@2019 Frank G. Anderson MD, all rights reserved

10 Parts That Develop From Being Hurt

 We also have parts that are normal aspects of our personality

 Creative, sensitive, loving & playful without burdens

@2019 Frank G. Anderson MD, all rights reserved

Trying to protect us from being hurt again

2 kinds of protectors parts

Try to prevent the wounds from being

14 Working with Preventive Parts

@2019 Frank G. Anderson MD, all rights reserved

@2019 Frank G. Anderson MD, all rights reserved

16 Stop the Pain

Extreme Parts Out Of Here Part

Pleasing Part Parts Involved in

Exile Carrying Feeling unloved

@2019 Frank G. Anderson MD, all rights reserved

Spiritual space for some

“A state of being”

20 ReSource Project (Tania Singer)

@2019 Frank G. Anderson MD, all rights reserved

@2019 Frank G. Anderson MD, all rights reserved

22 Self of the Therapist, Self of the Client

 Ideally looking for the therapist and the client to be in Self

 Accessing Self Energy Meditation

@2019 Frank G. Anderson MD, all rights reserved

@2019 Frank G. Anderson MD, all rights reserved

24 Starting an IFS Session

Listen to the range of parts

@2019 Frank G. Anderson MD, all rights reserved

26 The 6 F’s Working with Protective Parts

1. Find the Part

@2019 Frank G. Anderson MD, all rights reserved

@2019 Frank G. Anderson MD, all rights reserved

@2020 Frank G. Anderson MD, all rights reserved

@2020 Frank G. Anderson MD, all rights reserved

@2019 Frank G. Anderson MD, all rights reserved

What are you afraid would happen if you didn’t

@2019 Frank G. Anderson MD, all rights reserved

Overwhelm/ the pain is too much.

36 Summary- The Goal of Working with Protectors

Identify a target part

@2019 Frank G. Anderson MD, all rights reserved

@2019 Frank G. Anderson MD, all rights reserved

38 Working with Protectors- The 6 F’s

@2019 Frank G. Anderson MD, all rights reserved