Internal Family Systems Informed Eye Movement Desensitization and Reprocessing An Integrative Technique for Treatment of Complex Posttraumatic Stress Disorder

Abstract

Complex Posttraumatic Stress Disorder (C-PTSD) is a diagnostic entity included in the International Classifications of Diseases, 11 th revision (ICD-11). It denotes a severe form of posttraumatic stress disorder (PTSD) and is the result of prolonged and repeated trauma. C-PTSD is associated with a broad spectrum of psychopathological symptoms and transcends the typical diagnostic criteria for PTSD. C-PTSD is conceptualized as including the core elements of PTSD, such as re-experiencing, avoidance, and hypervigilance, with the additional symptoms of poor affect regulation, negative self-concept, and difficulties in establishing and maintaining healthy interpersonal relationships. Eye Movement Desensitization and Reprocessing (EMDR) and the Internal Family Systems (IFS) model share a common treatment approach, and their integration has been found to enhance the efficacy of both modalities in the treatment of complex trauma. This article explores IFS-informed EMDR (IFS-EMDR) for the treatment of C-PTSD. IFS-EMDR creates an integration of the contemporary practice of EMDR with the interweave of the IFS model for positive resourcing. This article will firstly provide an exploration of insecure attachment and relational trauma as diathetic factors to the development of C-PTSD. Subsequently, this article will review how trauma and the emergence of structural dissociation impact the development of the self through the lens of IFS. Finally, through the use of a composite case study, this paper will discuss the benefits of integrating IFS strategies and language into EMDR therapy, with particular attention to challenges and limitations.

Full text

112 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL Volume 19 Number 2 Fall/Winter 2020/2021
Received: 20.12.2019
Revised: 03.10.2020
Accepted: 06.10.2020
International Body Psychotherapy Journal
The Art and Science of Somatic Praxis
Volume 19, Number ,
Fall/Winter 2020/2021, pp. 112-122
ISSN 2169-4745 Printing, ISSN 2168-1279 Online
© Author and USABP/EABP. Reprints and
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ABSTRACT
Complex Posttraumatic Stress Disorder (C-PTSD) is a diagnostic entity included in the International Classifi-
cations of Diseases, 11th revision (ICD-11). It denotes a severe form of posttraumatic stress disorder (PTSD) and
is the result of prolonged and repeated trauma. C-PTSD is associated with a broad spectrum of psychopatho-
logical symptoms and transcends the typical diagnostic criteria for PTSD. C-PTSD is conceptualized as includ-
ing the core elements of PTSD, such as re-experiencing, avoidance, and hypervigilance, with the additional
symptoms of poor aect regulation, negative self-concept, and diculties in establishing and maintaining
healthy interpersonal relationships. Eye Movement Desensitization and Reprocessing (EMDR) and the Internal
Family Systems (IFS) model share a common treatment approach, and their integration has been found to en-
hance the ecacy of both modalities in the treatment of complex trauma. This article explores IFS-informed
EMDR (IFS-EMDR) for the treatment of C-PTSD. IFS-EMDR creates an integration of the contemporary prac-
tice of EMDR with the interweave of the IFS model for positive resourcing. This article will firstly provide an
exploration of insecure attachment and relational trauma as diathetic factors to the development of C-PTSD.
Subsequently, this article will review how trauma and the emergence of structural dissociation impact the de-
velopment of the self through the lens of IFS. Finally, through the use of a composite case study, this paper will
discuss the benefits of integrating IFS strategies and language into EMDR therapy, with particular attention to
challenges and limitations.
Keywords: C-PTSD, Internal Family Systems, EMDR, Trauma, Complex Trauma
Gillian O’Shea Brown
Internal Family Systems Informed
Eye Movement Desensitization
and Reprocessing
An Integrative Technique for Treatment of
Complex Posttraumatic Stress Disorder
ur early experiences with attachment figures set
a foundation for the development of our sense of
self and our future relationships. Children make
sense of the world by creating emotional maps to
aid their understanding of who they should trust and how they
will survive. When children’s needs are adequately met, they will
develop a secure attachment by believing that the world is an
intrinsically benevolent place (Bowlby, 1973). Conversely, when
children experience prolonged, repeated, interpersonal trauma,
they will have diculty establishing a sense of safety and main-
taining healthy relationships later in life (Lee & Hankin, 2009;
Main & Hesse, 1990; van Ijzendoorn, 1995). The negative eects
of complex relational trauma, particularly due to childhood abuse
and neglect, have long been recognized as contributors to the de-
velopment of Complex Posttraumatic Stress Disorder (C-PTSD)
(Cloitre et al., 2011; van der Kolk et al., 2005). Survivors of chronic
traumatogenic childhoods develop great deficits in aect regu-
“”
...the universal presence
of an untarnished self
exists within everyone...

Fall/Winter 2020/2021 Number 2 Volume 19 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL 113
lation, and consequentially have diculty exploring,
accessing, and processing painful memories (Krauze &
Gomez, 2013; Paulson, 2009). Eye Movement Desen-
sitization and Reprocessing (EMDR) and the Internal
Family System (IFS) model share a common approach,
and their integration has been reported to enhance the
ecacy of both modalities in the treatment of complex
trauma (Twombly & Schwartz, 2008; Twombly, 2014;
Krauze & Gomez, 2013).
The IFS model focuses on the network of internal rela-
tionships in which each ego state or part is embedded
(Schwartz, 1995). This is reminiscent of how family
therapy works, in that it is based on the assumption that
for any one family member to change, the entire fami-
ly system must change. IFS requires therapists to trust
that a healing self-wisdom lies within each client. This
is one of the commonalties that bridges the two power-
ful yet diverse modalities of IFS and EMDR, as therapists
with a background in EMDR also utilize a client’s innate
healing abilities (Twombly & Schwartz, 2008). IFS-in-
formed EMDR integrates the practice of EMDR with the
IFS model to promote positive resourcing, cognitive
interweaves, and the restoration of balance. The utili-
zation of IFS language and principles can enhance the
trauma survivor’s capacity to establish trust, tolerate
stabilization, and navigate a core sense of self (Forgash
& Knipe, 2008; Lobenstein & Courtney, 2013; Twombly
& Schwartz, 2008).
This current paper will first provide an exploration of
insecure attachment and relational trauma as diathet-
ic factors to the development of C-PTSD. Secondly, the
ways in which trauma and the emergence of structur-
al dissociation impact the development of the self will
be reviewed through the lens of IFS. Subsequently, an
overview of EMDR as a psychotherapeutic modality for
treating complex trauma will be provided. A composite
case will then be described to illustrate how IFS-in-
formed EMDR is administered. Finally, reflections of the
benefits and challenges of integrating IFS-psychother-
apy into EMDR therapy will be discussed, including the
existing limitations, and recommendations for guiding
future practice.
Deconstructing C-PTSD
A Diathesis Stress Model Perspective
The diathesis stress model posits that when an individ-
ual is exposed to adverse life events in their formative
years, they develop a negative self-schema (Slavich &
Auerbach, 2018). This schema remains dormant until
an individual experiences a traumatic life event that is
reminiscent of the original stressor, at which point the
preexisting schema or vulnerability becomes activated
as a central negative cognition (Ingram & Price, 2001).
Psychological diatheses are conceptualized as relative-
ly stable individual dierences (e.g., personality traits
or cognitive styles) that increase one’s vulnerability to
stress and to the development of psychological disor-
ders (Ingram & Price, 2001). According to the additive
model, an individual with a significant diathesis might
require only a minor stressor or adverse life experience
for a disorder to develop (Rutter, 2007).
One particularly potent early life stressor is parental
maltreatment. Parental maltreatment is a direct pre-
cursor to the development of disorganized attachment
in children, and is associated with children displaying
comfort seeking, trust diculties, and fear of rejec-
tion, abandonment, or betrayal (Collins & Read, 1990;
Granqvist et al., 2017). Adverse or traumatic events in
one’s childhood can predispose them to psychopathol-
ogy later in life, including C-PTSD (van der Kolk, 2015).
C-PTSD is a diagnostic entity included in the Interna-
tional Classifications of Diseases, 11th revision (ICD-11),
and denotes a severe form of PTSD as a result of pro-
longed and repeated trauma. Endorsement of the ICD-
11 definition of C-PTSD will go into eect on January
1, 2022. C-PTSD transcends the typical diagnostic cat-
egory of posttraumatic stress disorder (Herman, 1992)
in that it includes the core elements of PTSD, such as
re-experiencing, avoidance, and hypervigilance, in ad-
dition to symptoms of poor aect regulation, negative
self-concept, and diculties in establishing and main-
taining healthy interpersonal relationships (Cloitre et
al., 2011; van der Kolk, 2015; van der Kolk et al., 2005).
Trauma informs identity not just through the develop-
ment of maladaptive behaviors, such as hypervigilance
and psychological reactivity to events, but also through
the formation of shame-based cognition (Shapiro &
Forrest, 2016). Many children adopt a moral defense as
a coping strategy, blaming themselves for their parent’s
ineective parenting. Fairbairn (1943) described the
defense mechanism “The Moral Defense Against Bad
Objects” as self-destructive, but also a desirable strate-
gy for neglected children in order to remain attached to
their needed objects. Fairbairn posits that children ac-
tively internalize the “badness” of their parental objects
as a defensive strategy, which later causes them to feel
deeply ashamed of themselves. Children who use the
Moral Defense assume that their punishment or neglect
is deserved, perhaps because of their own inadequacy
(1943). The experience of trauma in the formative years
and/or maltreatment by attachment figures creates a
vulnerability to severe emotional dysregulation, along
with intense feelings of despair, anxiety, shame, and
mistrust of others later in life (Wesselmann et al., 2012;
Wesselman & Potter, 2009).
The psychological phenomenon of reenacting trau-
matic events and their circumstances has been coined
the “repetition compulsion” (Freud, 1914). Repetition
compulsion is attributed to both our predisposition
to drift towards the familiar, and our desire to rewrite
the past. This further demonstrates that the experience
of attachment-based relational trauma in the forma-
tive years creates a vulnerability to severe emotional
dysregulation along with intense feelings of despair,
shame, and mistrust towards others later on in life.

114 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL Volume 19 Number 2 Fall/Winter 2020/2021
Therefore, clients who meet the diagnostic criteria for
C-PTSD are often actively re-experiencing aspects of
their early relational trauma. If left unresolved, this at-
tachment reenactment will likely impede individuals’
progress over the course of clinical treatment.
Trauma and the Multiplicity of
the Mind Through the Lens of IFS
Trauma survivors often present as fragmented in their
sense of self (Janet, 1889; Siegel, 1999). Dissociative
splitting is a natural part of trauma and allows the in-
dividual to survive in a precarious environment through
the use of cognitive dissonance (Siegel, 1999; van der
Hart et al., 2006). Dissociative splitting enables trau-
ma survivors to disown certain undesirable parts of
the self that are related to shameful memories. Trau-
ma-related spitting and compartmentalization creates
a dissociative wall for relief from the painful remnants
of the trauma, including implicit memories, intrusive
thoughts, shame-based cognition, and night terrors
(Shapiro, 2007). However, this dissociative splitting
leads to a disowned part of the self through the appli-
cation of selective attention, and thus, internal conflicts
are left unresolved and implicit memories suppressed
(van der Hart et al., 2006). The central negative belief
adopted by many trauma survivors is that the trauma is
in some way their fault, and their burden to carry (Fair-
bairn, 1943; Shapiro, 2007). The disowned parts of the
personality are reminiscent of isolated neural networks
carrying maladaptive information (Siegel, 1999; van der
Hart et al., 2006). When disowned parts are activated,
survivors of trauma re-experience the aect, negative
cognitions, and behaviors stored in the unmetabolized
traumatic memories, which contribute to the client’s
fragmented recollection of the trauma, maladaptive be-
haviors, and negative self-beliefs. There are many ther-
apeutic modalities that work with ego states and sche-
mas, including ego state therapy (Watkins & Watkins,
1997), Gestalt therapy (Perls, 1973) and Internal Family
Systems (IFS) therapy (Schwartz, 1995).
Central to the IFS model is the belief that everyone has
a self-leadership quality that, when accessed, allows for
inherent healing and self-wisdom to emerge. The IFS
model proposes that the universal presence of an un-
tarnished self exists within everyone, and that this self,
referred to as “self-energy,” encompasses qualities of
calmness, curiosity, compassion, confidence, courage,
clarity, connectedness, and creativity (Schwartz, 2001;
Schwartz & Sweezy, 2020). The IFS model posits that
in addition to the self, there is an ecology of relatively
discrete, autonomous parts, and that each contains a
unique quality and holds a valuable role. IFS healing oc-
curs in a series of methodical steps that include access-
ing the self, witnessing all parts, retrieval, unburdening,
replacing burdens with positive qualities, and integra-
tion/reconfiguration of the system (Schwartz & Sweezy,
2020). The initial phase of the IFS treatment process is
to dierentiate parts from the self, or to unblend parts
from the self, as the self can become blended with other
parts. When parts become blended to the “self,” the in-
dividual is not being “self-led.” Once the self has been
accessed and a part has been identified that is willing
to work with the self, other parts are asked if they have
any objections to the work. Once permission is earned
and agreement is established, the process of compas-
sionate “witnessing” can occur. During this time, it can
become apparent that certain parts must be “retrieved.”
Retrieval is the process by which “the self” takes a part
out of the past and into the present. The “self” is best
equipped to lead the family system, and to heal the oth-
er parts of the mind. Initially, people may have limited
access to the self; however, a clear connection to the
self develops over time (Schwartz & Twombly, 2008).
IFS provides an essential language to access and un-
derstand the parts, in addition to working through any
unresolved internal conflicts. The IFS therapist works
as an ally alongside the client’s self, which eventually
becomes the compassionate therapist and leader of the
internal family system.
Trauma and attachment injuries may cause parts to be-
come burdened by extreme negative beliefs and worries
(Schwartz, 2001). Every part has positive intentions for
the person, even if actions at times are perceived as re-
sistant, dysfunctional, or maladaptive. The burdens that
parts carry are what cause problems, and parts must be
unburdened for deep healing to occur. “Managers” are
protective parts that manage an individual’s interac-
tions within their external environment in order to pro-
tect them from pain or re-traumatization. In traditional
psychodynamic therapy, the manager would be charac-
terized as the defenses. Similar to parentified children,
these manager parts protect more vulnerable parts in
the system (Schwartz & Twombly, 2008). “Exiles” are
disowned parts that are in active pain, shame, or fear.
The exile represents the wounded inner child that re-
sides within all of us. By accessing the inner child, we
can pave the way for deeper healing, in addition to
more profound behavioral and emotional change. Jung
(1940/1958) proclaimed that within every adult exists
an eternal child that is perpetually in a state of becom-
ing more, and requires nurturing through unceasing
care, attention, and education. Similarly, the IFS thera-
pist will seek to arm and unburden the exile.
Finally, “firefighters” are parts that emerge when man-
agers become overwhelmed or exiles are exposed. The
primary role of firefighters is to divert or suppress pain,
which is usually achieved through ritualistic, compul-
sive, comfort-seeking behaviors. or risky action urges.
Therefore, firefighters tend to be dominant in people
who live with addiction (Schwartz, 2001). Schwartz
(1995) states that there is never any reason to fight with,
coerce, or try to eliminate a part, and, similarly, the IFS
model promotes internal wholeness, balance, and har-
mony. The length of treatment in IFS is indexed to the
systems level of trust for the self, and the level of po-
Internal Family Systems-Informed Eye Movement Desensitization and Reprocessing

Fall/Winter 2020/2021 Number 2 Volume 19 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL 115
larization between parts, rather than the severity of the
client’s symptoms (Schwartz & Sweezy, 2020). Finding
understanding for the dierent parts of the self can pro-
vide a remedy for negative symptoms, and eventually
empower the trauma survivor. The IFS model creates a
language for the trauma survivors to arm and unbur-
den their parts, allowing their self to lead the way.
EMDR and the Treatment
of Complex Trauma
The ecacy of EMDR therapy in the treatment of PTSD
has been well established in over 30 positive randomized,
controlled studies during the past three decades (Ah-
mad et al., 2007; Marcus et al., 1997; Marcus et al., 2004;
Shapiro, 2014; Wilson et al., 1997). Such research find-
ings have led the World Health Organization (2013) to
state that trauma-focused cognitive behavioral therapy
and EMDR are the only psychotherapy modalities rec-
ommended for the treatment of children, adolescents,
and adults who meet the diagnostic criteria for PTSD.
It is important to note that most of these study partic-
ipants dier from survivors of complex trauma with
chronic abuse and neglect histories in terms of symptom
presentation and capacity for tolerating trauma-focused
work (Korn, 2009). The treatment of complex trauma
should be phase-oriented, multimodal, and skill-fo-
cused, with a core emphasis on symptom relief and func-
tional improvement (Briere & Scott, 2006; Courtois et al.,
2009; van der Kolk, 2015). In the treatment of complex
trauma, the EMDR model is phase-oriented, highlight-
ing the importance of resource development strategies
that address the needs of patients with compromised
aect tolerance and self-regulation (Korn, 2009). EMDR
is a trauma resolution approach that involves a stand-
ard set of procedures and clinical protocols and includes
specific types of bilateral sensory stimulation. Specific,
focused strategies along with the bilateral stimulation
help access the patient’s dysfunctionally-stored mem-
ories and related aect. These approaches desensitize
the emotions and physical sensations, enabling them to
access adaptive material stored in the brain, and forge
new, positive associations to the original event. EMDR
classically involves eight phases, which include the fol-
lowing steps: (1) history-taking, (2) preparation and
stabilization, (3) assessment, (4-7) desensitization, re-
processing, closure, and finally (8) reevaluation (Shap-
iro, 2007). Importantly, the ecacy of EMDR is chal-
lenged when presented with complex layered trauma
and dissociation (Forgash & Copeley, 2008).
Akin to the IFS model, EMDR activates a healing process
in many clients, in which scenes from the past are wit-
nessed compassionately and parts are unburdened from
guilt and shame (Twombly & Schwartz, 2008). EMDR
incorporates the adaptive information processing (AIP)
model, which posits that memories of distressing expe-
riences are dysfunctionally stored in an unmetabolized
state within the memory networks of the brain. These
areas tend to keep hold of perceptions, negative beliefs,
aect, and body sensations that arose during the initial
experience (Shapiro, 2001). These unmetabolized mem-
ories, much like a “skipping disk,” will replay the most
distressing part of the memory, leading to intrusive
thoughts, shame-based cognition, and psychological
reactivity activated by sensitivity cues (Shapiro, 2001).
Therefore, clients presenting with C-PTSD will have
complex relationships with themselves and their attach-
ment figures that must be approached compassionately
by providing psychoeducation on dissociation and ego
states. Shapiro (2001) further hypothesizes that “there
is an innate, physiological system that is designed to
transform disturbing input into an adaptive resolution
and a psychologically healthy integration” (p. 54). Thus,
EMDR therapists acknowledge the presence of an innate
physiological healing system. EMDR therapists who un-
derstand how to sensitively and respectfully work with
the inner ecosystem of clients’ parts experience better
outcomes and fewer complications when working with
complex trauma (Forgash & Copeley, 2008; Twombly,
2000; Twombly & Schwartz, 2008).
IFS-Informed EMDR
EMDR is a modality that incorporates the brain and the
body. The foundational steps of the EMDR process in-
volve teaching aect regulation techniques to clients
and providing them with an understanding of dissoci-
ation and trauma processing through psychoeducation.
No healing from trauma can occur until a client experi-
ences a sense of safety in their body (Levine, 1997). The
preparatory steps of EMDR involve taking a compre-
hensive history and establishing an imagined “place of
comfort” for the client before they can begin to identify,
communicate, and work with their parts. For clients liv-
ing with dissociative splitting, problems may arise if the
standard EMDR procedures are used without additional
measures to prepare the client to access painful ma-
terial (Forgash & Copeley, 2008). IFS-informed EMDR
provides a conceptual bridge between the two models,
providing additional language and tools to enrich ther-
apist-client communication when exploring the client’s
internal processes. Integrating IFS into the standard
EMDR protocol provides additional perspective for the
IFS-trained EMDR therapist in terms of ego states,
defenses, and relational phenomena, which can cause
blocking beliefs and resistance to trauma processing.
IFS-Informed EMDR
Adapted Protocol Phases 1 and 2
The initial phase of EMDR uses history taking as the
foundation for treatment planning. History taking in-
volves the therapist conscientiously observing and
gathering information about the client’s background
information, while assessing their suitability for EMDR.
In the initial phase of the history taking, the utilization
Gillian O’Shea Brown

116 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL Volume 19 Number 2 Fall/Winter 2020/2021
of IFS can be a valuable therapeutic tool for working
with clients. Particularly, the use of IFS language during
this initial phase of EMDR can help to titrate otherwise
overwhelming material (Gomez & Krause, 2013). Highly
dysregulated clients may find it overwhelming to ac-
cess painful and traumatic material, which can have an
impact on their aective states (Korn, 2009). Eective
treatment of complex trauma requires a therapist to be
experienced in working with dissociative parts. An IFS-
trained EMDR therapist may begin to listen reflectively
and use parts type language during the history-taking
phase. For instance, they might say: “It sounds like there
are multiple parts of you struggling here--one part that
feels fearful, and also one that wants to numb out. Is that
correct?” An IFS-trained EMDR therapist will contract
with the part that emerges during this time, become
curious about it, and learn about its unique function,
role, and desire. The client’s self will compassionately
witness this part, ensuring it is unblended from the self.
The client will then be encouraged to “go inside” and
connect with their reactions to external triggers. During
this phase, IFS helps stabilize the client by organizing
the sense of self and making sense of the internal ex-
perience. This preparatory stage involves psychoeduca-
tion, self-exploration, and acceptance of the multiplic-
ity of the mind, and is highly complementary to EMDR
phases one and two.
The second of phase of the EMDR protocol focuses on
preparation and provides clients with tools that will
prepare them for EMDR readiness. This involves en-
hancing their capacity to independently tolerate posi-
tive aect regulation. IFS is a tool that can be used with-
in the larger framework of a phase-oriented approach to
the treatment of complex trauma and is therefore com-
plementary to the history-taking and aect-regulation
phases of EMDR. The self-states identified through IFS
can assist with the identification of target development
within EMDR. By focusing on befriending and hearing
from parts, one can create the healing process of unbur-
dening. However, there are times when protective parts
block access to trauma wounds, which is when incorpo-
rating EMDR may be most eective. The gentle, arm-
ative language of IFS, combined with EMDR’s focused
strategies and bilateral stimulation, help access the cli-
ent’s dysfunctionally-stored memories so that deeper
healing can occur (Twombly & Schwartz, 2008).
Case Study
The following case study is a composite case that con-
tains elements and techniques derived from a number of
sessions. Grant
1
is a 27-year-old Caucasian male with a
diagnosis of C-PTSD. Grant presented to psychotherapy
treatment with symptoms of anxiety and shame-based
cognition due to a past history of emotional abuse,
which was reported as prolonged exposure to domes-
tic disputes and paternal aggression in childhood. This
abuse was attributed to parental mental illness and the
acrimonious divorce of his parents during his formative
years. Grant described symptoms of cognitive hyper-
arousal, as well as avoidance and numbing, that were
triggered during relational discord – specifically times
when he reported that he felt “not in control.” Histo-
ry taking revealed a pervasive negative cognition: “I
am powerless.” Grant responded well to imagined af-
fect-regulation techniques, “place of comfort,” and
“container” during the stabilization phase. The follow-
ing excerpt demonstrates introducing the IFS model
to Grant; he is guided toward accessing the self while
making sure to unblend it from a manager part. Subse-
quently, Grant’s self is able to compassionately witness
the part and perform a retrieval by letting the part know
that it is in present time, and the risk of harm has passed.
T: I want to introduce you to a model of therapy that
we will use together. It is based on the idea that we
all have a core self that embodies our essence and all
of our finest qualities, including calmness, curiosity,
compassion, confidence, courage, clarity, connect-
edness, and creativity. We are born with these qual-
ities; this is known as self-energy. However, we are
also born with parts that help us relate to and sur-
vive in the world. You have heard the language, “One
part of me feels sad but another feels mad,” or “On the
one hand, I want this, but on the other, I want that.” It
will be helpful to get to know these dierent parts
of the mosaic mind. Some of these parts take on the
role of protectors, keeping us safe from harm. They
may do this in an outwardly positive way; for exam-
ple, counteracting feelings of inadequacy by over-
working and becoming perfectionistic. However, the
fears of this part may cause anxiety, exhaustion, and
a lack of belief in one’s intrinsic value. Other parts
may protect us in ways that have a more negative ef-
fect. For example, a part may attempt to protect from
painful thoughts or memories by using alcohol as a
numbing agent. Though this can be used as a tem-
porary way to avoid inner pain, the damage it causes
to health, general wellbeing, and relationships is not
helpful. Everyone has “parts” or facets of the self.
All parts are welcome, and all parts are in some way
attempting to be helpful. In this model, we develop
a way to communicate with all the various parts of
you, finding a way to hear from them so that they
can heal rather than be pushed away. Our goal is to
get to know them better, to earn their trust, and un-
derstand their underlying hurts. When we heal and
unburden parts, they no longer feel the need to lead
or be intense, because they begin to trust that you
are now safe. You mentioned before that you have a
particular part that seems to sabotage your relation-
ships. Would you like to get to know this part better
to see if we can help it?
1. A pseudonym has been used to preserve confidentiality.
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Fall/Winter 2020/2021 Number 2 Volume 19 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL 117
C: (nods) Yes, I’d like that.
T: How does this part show up? Do you notice it in or
around your body… or perhaps visually?
C: It’s visual.
T: Can you tell who and what you see?
C: Yes, this part is a pacing detective. He looks pensive
and highly anxious.
T: Are there words that go with this image?
C: Yes, the detective is shouting and cursing. He is so
stressed and has no control. He is fearful.
T: It sounds like this is a fearful part; what shall we call
it?
C: Yes, he is fearful… we can call it the fearful part for
now.
T: How do you feel towards the fearful part?
C: I feel critical of this part. It’s not a helpful response
to have.
T: Can you ask the critical part to step back/relax for a
moment?
C: No, it doesn’t want to step back.
T: What is this part afraid would happen if it stepped
back?
C: It would be too much to handle, possibly overwhelm-
ing.
T: If we could take just a few minutes to get to know and
hear from the critical part, would that be okay?
C: Yes.
T: Thank you for creating the space to get to know this
critical part. How do you feel towards this part?
C: It’s been with me for a long time. It is fearful of get-
ting hurt.
T: Oh, I see… tell me more.
C: It doesn’t want me to get hurt again.
T: This part does not want you to get hurt again. How
does this part serve you?
C: Yes, it protects me.
T: What shall we call this part?
C: The protective part.
T: How do you feel towards this protective part?
C: I appreciate it; I know it does not want me to be vul-
nerable or hurt.
T: Would it feel okay to send this part a signal of your
appreciation?
C: Yes.
T: Is this part willing to give us permission to be with
the fearful part?
C: Yes.
T: Okay, take a moment to thank this protective part,
letting it know you will listen for and appreciate its
guidance. And then, when you are ready, you can
connect with the fearful part.
C: Okay, this part feels more appreciated. I will listen
for it more.
T: How do you feel towards this fearful part?
C: I am interested in this part, but I don’t like his ener-
gy– too much pacing.
T: Does this part know you are here with him?
C: No.
T: Would you like to send this part a signal of your curi-
osity and calmness?
C: Yes.
T: Does this part sense your presence?
C: Yes, but I am very far away.
T: Would it be okay to get closer to the part?
C: Yes, I approached him and placed a hand on his
shoulder. He turned around and we are making eye
contact.
T: What would you like to say to this part?
C: We are safe; you don’t need to be afraid anymore.
T: Can you ask this part, “What is this part afraid would
happen if you did not listen to it?”
C: He is afraid that I would feel vulnerable and hurt.
T: That’s understandable; there have been many times
when you have been made to feel this way in the past.
C: Yes, there have been. He is the protector of a younger
me.
T: Do you want to tell this part about who you are now?
C: Yes, it’s 2020 now, and I am strong, independent,
and live in a peaceful home.
T: Does this part have a response?
C: This part was so busy protecting me, it did not know
that so much time had passed. This part has worked
so hard. He is exhausted.
T: Do you want to thank this part?
C: Thank you for being there for me, for protecting me.
I have felt your presence. This part is focused and
powerful.
T: Can we hear from this part?
C: This part is relieved, but tired, very tired.
T: I wonder if you would like to let this part know that
you appreciate its value and that you will continue to
visit it and build a relationship.
C: He would like that.
T: If you like, maybe you could let this part know that
you will be listening for its guidance.
C: Yes, that feels good and right. I will check in on him
when I feel anxious or fearful.
T: Let’s take a moment to thank these parts for showing
up today. In your own special and meaningful way,
say goodbye to these parts, letting them know that
you will continue to connect with and build a rela-
tionship with them.
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118 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL Volume 19 Number 2 Fall/Winter 2020/2021
C: Yes, that felt good.
T: This is your internal family system. All parts are wel-
come, and all parts are valuable. When we hear from
these parts, we may learn of their core beliefs, fears,
and burdens, and in time perhaps negotiate with
them to harmonize and unburden them.
IFS-Informed EMDR
Phases 3-5
Within the parts work therapy, the IFS-trained EMDR
therapist can begin to work towards achieving trauma
resolution by recognizing parts and giving these parts
a voice to express their needs within the internal family
system. The objective is to support the client in develop-
ing an embodied sense of self that can compassionately
hold all disparate emotions, vulnerable sensations, and
young parts of self as they strive towards internal har-
mony. Furthermore, certain ego states can be utilized
as positive interweaves when a client demonstrates re-
sistance to processing and cognitive looping (Twombly
& Schwartz, 2008). The IFS concept of self-leadership
provides a valuable context for the resource installa-
tion and the cognitive interweaves utilized in EMDR.
Identifying potential target memories for processing
can be a very charged and sensitive time in the trauma
treatment process. However, careful integration of the
IFS-informed preparation and resource development
can aid in the assessment and identification of specific
targets and core components of memories (Twombly
& Schwartz, 2008). From here, the client will develop a
sense of readiness and self-energy as they work towards
the phases of desensitization and installation. This de-
velopment of self-energy, catalyzed by interweaving
IFS into the EMDR process, increases the connection
to positive cognitions and adaptive neural networks.
Phases 3-5 of EMDR can be a crucial time for assessing
a client’s readiness to tolerate EMDR reprocessing. IFS
can be applied to this pivotal process via the integration
of parts type language to facilitate development of tar-
get memories, central cognitions or schemas, feelings,
and the identification of somatic sensations (Twombly
& Schwartz, 2008; Krauze & Gomez, 2013).
Even though a client may verbally express a sense of
readiness to process the pain of the past, certain parts
of self, such as firefighters or managers, may come to
the surface and interfere with the process to protect the
client. Twombly & Schwartz (2008) caution that EMDR
can sometimes override managers and access exiles be-
fore systems have been prepared to handle them. Con-
sequentially, managers and/or firefighters will punish
the client and/or therapists for violating their rules. This
sort of therapeutic backlash can result in the client dis-
tancing from therapy, disengaging, numbing out, dis-
sociating, or activating firefighter-like behavior, such
as increased alcohol use or risk-taking (Schwartz, 2001;
van der Kolk, 2015). Sometimes, hypervigilant managers
can become blended with the self. Within IFS, there is a
direct access technique that may need to be applied if
there is considerable self-energy available to the client,
but a protective part is impeding the work (Schwartz,
2001). Direct access is an alternative approach to in-
sight wherein the therapist’s “self” speaks directly to
the client’s “parts.” Direct access can be accomplished
as an explicit intervention, or implicitly, if the therapist
knows but does not reveal that they are speaking direct-
ly to the client’s parts. This technique must come from
self-energy, or it will exacerbate mistrust (Schwartz &
Sweezy, 2020). Additionally, therapists must be mindful
of their own aect, thought process, and countertrans-
ference. Before commencing with phases 3-5 in Grant’s
treatment, we worked through hearing from and nego-
tiating with the part via direct access in order to obtain
consent to process a memory of developmental trauma,
which had previously been blocked by a protective part.
T: In our last session, you identified a target memory
that you would be interested in reprocessing.
C: Yes, I am sitting at the old dining room table with my
sister across from me. I am next to my mom in the
kiddy corner. It’s in the evening and it is very sol-
emn. I want to process this memory; however, there
is a part of me that questions what good can come
from it?
T: Can I hear more from that part?
C: I don’t think he wants to talk; he is just pacing.
T: Grant, remember all parts are welcome, and all parts
serve a function. Can we be curious about what he has
to say? Let’s hear from him.
C: It’s the detective (the fearful part). He is anxious
about going into this memory.
T: Tell me more.
C: In the other memories, I did not face my father. I
trust you and have felt safe here before when work-
ing on the other memories. However sometimes
when I think of my father, I feel a pressure in the
back of my throat. It is a feeling of frustration, and a
sort of despair.
T: I see. It sounds like this part is coming in to protect
you.
C: Yes, he comes in when I feel that I am weak.
T: Can we hear from this part?
C: I work very hard to protect him. As far as intelligence
and application go, I am doing my job.
T: You have done a wonderful job as Grant’s protector.
You served as his protector when no one else did, and
you have been loyal to him for all of these years. I am
grateful to you for that.
C: I am glad that you can see that.
T: You have worked very hard to protect. What are you
protecting him from right now?
C: When he tries too hard, he gets hurt. Then he feels
weak.
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Fall/Winter 2020/2021 Number 2 Volume 19 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL 119
T: I understand; it sounds like you do not want him to
get hurt or to feel weak.
C: Yes, my job is to protect him from pain.
T: You have done a great job of shielding Grant from
pain and keeping him safe. Grant, do you have words
for your protector, the detective?
C: Yes, I can see that the detective has been my protec-
tor for a long time. Growing up, I really did not have
anyone who I could rely on, and his pacing and gen-
eral distrust kept hurtful people away.
In the IFS-informed interweave, it becomes apparent
that Grant’s manager was protecting him from the pain
of perceived failure. Consequentially, he is hesitant to
access a memory involving developmental trauma via
EMDR. Ultimately, this part revealed it would prefer
for Grant to avoid and numb out his painful memories,
as he had learned to do in his formative years. Trau-
ma often involves numbing and avoidance of memo-
ries that are too painful to lean into or hold in the mind
for a sustained period of time. This is reminiscent of a
“jack-in-the-box motion” – a delicate dance of sup-
pression and intrusion, which can be both pervasive and
distressing. Suppression conceals the disowned parts;
however, intrusive thoughts and memories can come to
the surface and provoke feelings of fear and powerless-
ness in the trauma survivor. Finding a language and an
understanding for the dierent parts of self can reme-
dy these symptoms and empower the trauma survivor.
Grant is guided towards appreciating and arming that
this part has been instrumental in ensuring his surviv-
al in a dysfunctional family home. The next step of this
IFS-informed interweave involves negotiating with the
protector part to obtain its permission to heal the parts
that had been previously devastated by disappointment
and perceived failure. This protective part believes that
pain and suering are pervasive themes in Grant’s life.
The idea of exploring painful feelings seems risky, con-
sidering that in his formative years, Grant was shamed
and rejected for being “too emotional.” The clients’ dis-
trusting protector monitors trustworthiness to reduce
pain. Reconnecting with, honoring, and eventually un-
burdening that part are the turning points in IFS-EMDR
therapy. A hallmark of IFS is the belief that beneath the
surface of their parts, all clients have self-leadership.
Through Grant’s IFS journey, his self-energy has be-
come more accessible.
T: The detective has done a wonderful job as a protec-
tor; I wonder if there is anything you would like to
say to this part?
C: (pauses thoughtfully) Yes, you are doing well; the path
should be clear to you now. You have done much of
the hard work and preparation to make way for heal-
ing. I know you are drained. You have carried me
through pain for a long time. You must push through
this resistance and be okay with surrendering. In an
earlier time, you felt fearful and powerless, but now
you are strong and capable.
T: Thank you for reminding him that he is strong and
powerful. Let’s give him the space to respond.
C: I have always known, but sometimes I feel forgot-
ten (laughs a little). He is ready; I will still watch over
him, but he is ready.
T: As the protector, you are forever balancing the duty
of care versus the dignity of risk. You are his dutiful
protector. However, the risk is to give him the wings
to fly and a safe space to land. Are you ready to let
him process this memory?
C: I am.
T: Let’s take a moment to see if there are any parts of
you that need to speak or weigh in on this important
decision of processing a memory involving your fa-
ther.
C: We are all ready.
IFS-Informed EMDR
Phases 6-8
In the final stages of EMDR, the IFS-oriented psycho-
education and resourcing can continue to strengthen a
client’s positive resourcing and resilience. For instance,
in phase 6 of the body scan, which is designed to bring
awareness to the body and process any residual dis-
turbances, the client can connect somatic sensations
with certain parts. For example, the somatic symptom
of tightness in the throat can indicate the sensations of
choking back tears, or the words they never got to say.
Therefore, a client may say, “Even though the memory
has retreated to a lower level of distress, I continue to
experience a tight sensation in the throat.” This would
prompt the IFS-trained EMDR therapist to ask, “Is
there a part of you that we must hear from who needs
a voice?” This gentle navigation of the mind-body re-
lationship promotes closure by ensuring stability at the
end of treatment. Once again, remnants of trauma are
revisited in a monist perspective during the final stage
of reevaluation using IFS-informed language. Further-
more, finding and nurturing the self can be utilized as a
resource in both the EMDR processing and the installa-
tion stages. This creates a gentle, warm, and empathic
integrative trauma approach to guide those suering
from trauma towards a place of healing and self-com-
passion.
Conclusion
EMDR is an eective and empirically-supported trauma
modality that can benefit greatly from the integration of
the IFS model. The IFS approach enables clients to rec-
ognize internal ego states, and to structure and control
internal communication. Clients become aware of vari-
ous parts and are able to identify alliances and conflicts
among these parts. By exploring and compassionately
connecting with dierent parts, clients can strength-
en their “core self” and connect with their own inter-
Gillian O’Shea Brown

120 INTERNATIONAL BODY PSYCHOTHERAPY JOURNAL Volume 19 Number 2 Fall/Winter 2020/2021
nal guiding voice. IFS is a highly compatible adjunctive
strategy to EMDR psychotherapy, as it capitalizes on a
language optimized to understand the parts of the self
in order to foster cooperation and self-energy. Further-
more, EMDR’s adaptive information processing mod-
el promotes the development of the internal working
model, scaolding the client through a comprehensive
understanding of the mechanisms causing them to un-
consciously reenact their trauma. IFS-EMDR creates
a unique blend of the contemporary practice of EMDR
with the interweave of IFS for positive resourcing. This
has been shown to enhance the trauma survivor’s ca-
pacity to establish trust, tolerate stabilization, and
navigate a core sense of self (Forgash & Knipe, 2008;
Lobenstein & Courtney, 2013).
One primary aspect of this approach is the re-
search-based knowledge that trauma is often accom-
panied by dissociation (van der Kolk et al., 2005; van
der Kolk, 2015; Korn, 2009). Importantly, dissociation
psychoeducation and aect-regulation techniques are
standard strategies in treating complex trauma through
psychotherapy. As discussed previously, dissociation is
best understood as parts through the perspective of an
ego state tradition. An IFS relational approach asserts
the need for parts and provides the client with language
to engage in a dialogue that facilitates self-compassion
and positive resourcing. The ultimate goal of IFS work
is to transform the internal dialogue between the parts
of the self from disjointed chaos to a smooth, harmonic
symphony. The parts are interwoven into the EMDR pro-
tocol and work collaboratively toward trauma healing.
Consequently, in the healing of past painful events and
the negative self-concept, clients are guided through a
journey of positive self-energy and empowerment. As
EMDR can successfully reprocess maladaptively-stored
distressing memories and create new, adaptive associ-
ations in the brain, targeting early attachment-related
memories with EMDR should have a positive impact on
the individual’s internal working model. The IFS model
depathologizes trauma-related splitting and empow-
ers the client to ensure that deeper healing can occur.
By applying concepts and methods from the structure,
strategies, and narrative of family therapy and subper-
sonalities, the IFS model provides a language necessary
to understand one’s parts and work through unresolved
internal conflicts. Chronic traumatization can lead to
internalized shame and negative cognitions. However,
by compassionately hearing from dierent parts of self
and developing self-energy, one can reprocess trauma
and become unburdened from feelings of shame, there-
by paving the way for trauma healing and self-leader-
ship.
  
Gillian O’Shea Brown, LCSW is an Irish-born psychotherapist and EMDRIA-certified therapist. She is
author of the forthcoming book Healing Complex Posttraumatic Stress Disorder: A Clinicians Guide, due for
release in Spring 2021. She has trained at University College Cork, New York University, and the National
Institute for the Psychotherapies. She currently serves as adjunct faculty at NYU and maintains a private practice in Manhattan,
New York.
Email: gillosheabrownlcsw@gmail.com
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