Internal Family Systems

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ivan_alyosha

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Hi,

I’m a PhD student starting a new practicum in a few weeks. The supervisor recently told me they are “interested” in internal family systems therapy (IFS) although they primarily work under a CBT umbrella.

I’m trying to read more about IFS - it seems a little out there. Does anyone have experience/insight/some papers that coherently explain it? The idea that there are multiple parts of ourselves with distinct roles is not something that strikes me as particularly evidence based, but I could be missing or misunderstanding.

Thanks!

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Hi,

I’m a PhD student starting a new practicum in a few weeks. The supervisor recently told me they are “interested” in internal family systems therapy (IFS) although they primarily work under a CBT umbrella.

I’m trying to read more about IFS - it seems a little out there. Does anyone have experience/insight/some papers that coherently explain it? The idea that there are multiple parts of ourselves with distinct roles is not something that strikes me as particularly evidence based, but I could be missing or misunderstanding.

Thanks!

This is putting it lightly.
 
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Ok, thanks for confirming my suspicions! I personally found it pretty odd but hey, trying to keep an open mind here.

ACT is actually very appropriate for our population and one of the modalities my supervisor uses, so I think the “parts as metaphor” might do the trick here. Thanks.
 
What's weird is that IFS wasn't mentioned in the 2024 VA/DoD PTSD CPG. Not even in the myriad list of therapies with "insufficient evidence." Now all of a sudden I'm hearing about it everywhere
 
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Thinking about patterns of interaction that we have developed and where they came from can be helpful, but any therapy that focuses on that primarily is likely to be at best inaccurate but more likely harmful in my opinion and that is one reason why it is not going to have much research support.
 
1) I consulted my sub personalities, and we all agreed that IFS is BS, inconsistent with the personality literature, and inconsistent with the neural requirements to run multiple sub personalities.

2) Does IFS make every psychotherapy session into a group session? If yes, what is the maximum number of sub-personalities that you can bill for? IIRC, CMS says 12 to a group maximum.

3) My "scheming subpersonality" wants to know if "therapist Psydr subpersonality" can treat his 12 "daily life subpersonalities", and bill his own insurance for that. If yes, what is the maximum number of sessions I can bill in a 24 hour day?
 
I was trying to find a therapist for a family member a few months ago. *Every* (not hyperbole) masters level counselor in her 50k pop city had IFS listed in their psych today profile.
I have yet to see a masters level therapist listing that doesn’t advertise that they do EMDR, either. I’ve given up on any of my masters-level supervisees not being “strongly encouraged” to do EMDR by their site supervisors.
 
In the past year the clinic I work in has seen several patients come to us after working with IFS therapists and, not exaggerating here: I believe the IFS "work" did actual harm to the patients. A few patients believed that they essentially had DID.

I can't tell if this is because IFS is flawed, or because many of the people practicing IFS don't grasp the core tenets of it enough to competently use it.

Either way, it's gotten to the point that when a patient tells me they used to do IFS with a previous clinician, I brace myself.
 
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In the past year the clinic I work in has seen several patients come to us after working with IFS therapists and, not exaggerating here: I believe the IFS "work" did actual harm to the patients. A few patients believed that they essentially had DID.

I can't tell if this is because IFS is flawed, or because many of the people practicing IFS don't grasp the core tenets of it enough to competently use it.

Either way, it's gotten to the point that when a patient tells me they used to do IFS with a previous clinician, I brace myself.
Google the "Castlewood" lawsuit.
 
In the past year the clinic I work in has seen several patients come to us after working with IFS therapists and, not exaggerating here: I believe the IFS "work" did actual harm to the patients. A few patients believed that they essentially had DID.

I can't tell if this is because IFS is flawed, or because many of the people practicing IFS don't grasp the core tenets of it enough to competently use it.

Either way, it's gotten to the point that when a patient tells me they used to do IFS with a previous clinician, I brace myself.
What’s the deal with ****ty therapists and fixation on dissociation?
 
I like this thought from Dr. Charles Raison on DID as an extreme to consider: "Do I think that some people have many biologically distinct entities packed into their heads? No. I think that some people dissociate so badly that either on their own or as a result of therapeutic experiences it becomes the case that the most convincing way for them to see their own experience is as if it is happening to multiple people."

IFS doesn't address sub-personalities, it adresses psychodynamics. Old analysts had stuff like this going on all the time. Inner conflict as the basis of neurosis. Why can't each side of the conflict be considered separate parts and be voiced accordingly, considering the lesser dissociative faculty? And if it's an attitude that's generalizable, why can't those parts be given names? It's not like there's no simplifying jargon going on in other modalities.

Hang me by my toenails but it's not that crazy, and this thread reads just like another "us and them" with mid-level providers.
 
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What’s the deal with ****ty therapists and fixation on dissociation?
It's fun and sexy, just like all the "neuro" talk in EMDR. Possibly makes a provider feel like they're maybe more sophisticated and adept than they really are.

I do wonder how many of the providers on Psychology Today with IFS listed do so basically for marketing purposes. As in, "I'm not going to offer this to anyone, but if I don't have it on my profile, no one's going to want to work with me."
 
It's fun and sexy, just like all the "neuro" talk in EMDR. Possibly makes a provider feel like they're maybe more sophisticated and adept than they really are.

I do wonder how many of the providers on Psychology Today with IFS listed do so basically for marketing purposes. As in, "I'm not going to offer this to anyone, but if I don't have it on my profile, no one's going to want to work with me."

Similarly, how many people went to a three hour talk on a subject, and now list it as a specialty?
 
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Hang me by my toenails but it's not that crazy, and this thread reads just like another "us and them" with mid-level providers.
There are clinicians who believe in science and data, and those who believe in magical thinking; those two groups are not the same.
 
In the past year the clinic I work in has seen several patients come to us after working with IFS therapists and, not exaggerating here: I believe the IFS "work" did actual harm to the patients. A few patients believed that they essentially had DID.

I can't tell if this is because IFS is flawed, or because many of the people practicing IFS don't grasp the core tenets of it enough to competently use it.

Either way, it's gotten to the point that when a patient tells me they used to do IFS with a previous clinician, I brace myself.
I've wondered about the risk of DID with this approach as well. I can see it totally fitting into CBT if we just use the internal family idea as an extended metaphor for competing thoughts and desires, and perhaps the internalized standards of others. Hopefully that is how OP's supervisor intends it...
 
I've wondered about the risk of DID with this approach as well. I can see it totally fitting into CBT if we just use the internal family idea as an extended metaphor for competing thoughts and desires, and perhaps the internalized standards of others. Hopefully that is how OP's supervisor intends it...
A. You can’t have a risk factor for something that doesn’t exist. Definitely not possible for some bargain bin therapy approach to cause DID. OSIC said risk for *belieiving* they have DID, which is an important distinction.
B. Then why not just use CBT with some metaphors like everyone does?
 
A. You can’t have a risk factor for something that doesn’t exist. Definitely not possible for some bargain bin therapy approach to cause DID. OSIC said risk for *belieiving* they have DID, which is an important distinction.
B. Then why not just use CBT with some metaphors like everyone does?

Yeah, the same argument is used for other pseudoscience things like MBTI and the like, that it's a useful metaphor t get a conversation started. No, not really, it's pseudoscience that you are legitimizing. As you say, in empirically supported CBT and psychodynamic approaches, we already have countless metaphors that accomplish the same goal, all without pushing bad science. If you want to practice astrology, go ahead, get a head scarf, rent room and go bilk some rubes out of their money. But we're all, presumably, professionals in a healthcare field. Let's shun the BS, as we should, and actually start helping patients.
 
If you yourself are more evidence based and know much about ACT (evidence based 3rd wave Cbt approach), I have found it useful to do something similar to what Russ Harris describes in this pdf. It’s possible to utilize parts work as a metaphor and examine needs/yearnings and function without buying into the verbatim theories of IFS.

This is the only way I've ever seen it used. It still didn't seem like the most elegant way to deliver ACT but at least it was connected with an EBP.
 
IFS doesn't address sub-personalities, it adresses psychodynamics. Old analysts had stuff like this going on all the time. Inner conflict as the basis of neurosis. Why can't each side of the conflict be considered separate parts and be voiced accordingly, considering the lesser dissociative faculty? And if it's an attitude that's generalizable, why can't those parts be given names? It's not like there's no simplifying jargon going on in other modalities.

It actually does. Take a look at the reference I linked above--you'll see pretty quickly that central to the claims of IFS is the existence of interrelated personality structures whose 'dysfunction' represents the theory of psychopathology IFS purports to resolve. As you say, psychology has been here before and the weight of evidence has decidedly fallen towards cognitive-behavioral models due to its ability to be empirically tested. The same can't be said of classic psychoanalytic developmental theory because of its non-falsifiability and questionable data-collection methods used to prove its existence. Whomever it was you said who claimed otherwise (i.e., that IFS is a metaphor for dissociation) is betraying their own theory to make it more palatable to would-be skeptics. A real J.D. Vance move.
 
Linked on this very forum before, but there is the whole demon aspect to IFS as well:

I love this part at the beginning:
“Hot new psychotherapy” might sound dismissive. It’s not. There’s always got to be one. The therapy that’s getting all the buzz, curing all the incurable patients, rocking those first few small studies. The therapy that was invented by a grizzled veteran therapist working with Patients Like You, not the out-of-touch elites behind all the other therapies. The therapy that Really Gets To The Root Of The Problem. There’s always got to be one, and now it’s IFS.”

I’m so annoyed whenever therapies bill themselves as “really getting to the root of the problem.” A lot of times the “root of the problem” is that you got a bad diathesis stress hand and got sick.

(It reminds me of man I know about who died by suicide in his 60s despite undergoing years of psychotherapy—only the psychotherapy was all about exploring his “rejected bids for status” as a child and teenager and never addressed coping mechanisms, behavioral activation, cognitive distortion, emotional regulation, etc—it was all just focused on finding that “root of the problem”).
 
I love this part at the beginning:
“Hot new psychotherapy” might sound dismissive. It’s not. There’s always got to be one. The therapy that’s getting all the buzz, curing all the incurable patients, rocking those first few small studies. The therapy that was invented by a grizzled veteran therapist working with Patients Like You, not the out-of-touch elites behind all the other therapies. The therapy that Really Gets To The Root Of The Problem. There’s always got to be one, and now it’s IFS.”

I’m so annoyed whenever therapies bill themselves as “really getting to the root of the problem.” A lot of times the “root of the problem” is that you got a bad diathesis stress hand and got sick.

(It reminds me of man I know about who died by suicide in his 60s despite undergoing years of psychotherapy—only the psychotherapy was all about exploring his “rejected bids for status” as a child and teenager and never addressed coping mechanisms, behavioral activation, cognitive distortion, emotional regulation, etc—it was all just focused on finding that “root of the problem”).

How do people respond to this criticism of CBT that it's just really easy to research so that's why we have so much evidence in favor of it? Also, is it really true that CBT barely beats placebo?
 
How do people respond to this criticism of CBT that it's just really easy to research so that's why we have so much evidence in favor of it? Also, is it really true that CBT barely beats placebo?

"Research is hard" is just a lazy argument, probably the laziest from dull minds. Many of these methods have been around for decades at this point, and the critical studies have pointed out the easily fixable methodological limitations with their literature. For many of these things, they are readily researchable, it's just that the research has been found wanting.
 
How do people respond to this criticism of CBT that it's just really easy to research so that's why we have so much evidence in favor of it? Also, is it really true that CBT barely beats placebo?
I think that would depend on what your patient populations, outcomes, follow-up length, etc are.
 
How do people respond to this criticism of CBT that it's just really easy to research so that's why we have so much evidence in favor of it? Also, is it really true that CBT barely beats placebo?

That other non-CBT treatments have empirical support (interpersonal therapy, for example).
 
How do people respond to this criticism of CBT that it's just really easy to research so that's why we have so much evidence in favor of it? Also, is it really true that CBT barely beats placebo?

I tell them it's near they've never worked in intervention research, or that, if they have, they don't know much about it.
 
"subpersonalities" is literally the first bullet point of the "basic assumptions of the IFS model" page on the IFS website.
I have read Dick Schwartz because I wanted to learn more about the model. I’m glad you are good at reading websites. @R. Matey too, I detest the JD Vance comment, just shows your dogmatic mindset.

Edit: subpersonalities more than likely has a different definition, i.e. giving a word for the ‘generalizable attitude’ I mentioned in my first post. If you wanted to go after every psych concept or model for semantics I would be happy to continue our discussion in the afterlife (I don’t believe in the afterlife, don’t let me represent myself as too off course here🙂)
 
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"Research is hard" is just a lazy argument, probably the laziest from dull minds. Many of these methods have been around for decades at this point, and the critical studies have pointed out the easily fixable methodological limitations with their literature. For many of these things, they are readily researchable, it's just that the research has been found wanting.
Is it “research is hard” or “funding is hard”?
 
@R. Matey too, I detest the JD Vance comment, just shows your dogmatic mindset.

I have a great meme for this, but you're a regular poster here, and we're a pretty small community.

Disagree with me all you want, but ad hominems/feminines are uncalled for. It's bad form. My point is that your guy is claiming something about IFS that is verifiably untrue.
 
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I love this part at the beginning:
“Hot new psychotherapy” might sound dismissive. It’s not. There’s always got to be one. The therapy that’s getting all the buzz, curing all the incurable patients, rocking those first few small studies. The therapy that was invented by a grizzled veteran therapist working with Patients Like You, not the out-of-touch elites behind all the other therapies. The therapy that Really Gets To The Root Of The Problem. There’s always got to be one, and now it’s IFS.”

I’m so annoyed whenever therapies bill themselves as “really getting to the root of the problem.” A lot of times the “root of the problem” is that you got a bad diathesis stress hand and got sick.

(It reminds me of man I know about who died by suicide in his 60s despite undergoing years of psychotherapy—only the psychotherapy was all about exploring his “rejected bids for status” as a child and teenager and never addressed coping mechanisms, behavioral activation, cognitive distortion, emotional regulation, etc—it was all just focused on finding that “root of the problem”).
Yes, he did need a behavioral therapy to help him deal with his suicidality. It’s not either/or, models like psychodynamics, analytic, and IFS address gaining insight into the nature and origin, which can give people a logic to their mental health and a peace of mind before the activation even begins.
 
I have a great meme for this, but you're a regular poster here, and we're a pretty small community.

Disagree with me all you want, but ad hominems/feminines are uncalled for. It's bad form. My point is that your guy is claiming something about IFS that is verifiably untrue.
Memes noted!

I too am happy to value the relationship & forum-peace over a difference of opinion but calling something verifiably untrue without getting more specific is bad form so agree to disagree and leave the truth out of it. Cheers
 
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I have read Dick Schwartz because I wanted to learn more about the model. I’m glad you are good at reading websites. @R. Matey too

Edit: subpersonalities more than likely has a different definition, i.e. giving a word for the ‘generalizable attitude’ I mentioned in my first post. If you wanted to go after every psych concept or model for semantics I would be happy to continue our discussion in the afterlife (I don’t believe in the afterlife, don’t let me represent myself as too off course here🙂)
Sub-personalities on page 2 of Schwartz’ 2013 book. Then page 4, 5, 7, 27, 32, 34… 232.

I really like all the references to multiple personality disorder, and the “MPD movement”.

Then in the 2019 book, he says sub personalities are parts of the personality that behave like internal people on page 282.
 
Page 2 of Schwartz’ 2013 book. Then page 4, 5, 7, 27, 32, 34… 232.

I really like all the references to multiple personality disorder, and the “MPD movement”.

Then in the 2019 book, he says sub personalities are parts of the personality that behave like internal people on page 282.
Changing reading websites to Ctrl+Fing a PDF, haha. I don’t see how, in your last point, ‘sub-personalities’ being used in an example or analogy makes it literal.

“Behaves like” carries a lot of weight, and again, IFS is a tool for its underlying concepts, not ideas unto themselves.
 
Yes, he did need a behavioral therapy to help him deal with his suicidality. It’s not either/or, models like psychodynamics, analytic, and IFS address gaining insight into the nature and origin, which can give people a logic to their mental health and a peace of mind before the activation even begins.
But mental illness isn't always caused by something like being sightly rejected by peers as a child--sometimes (usually), it's just a bad hand that someone is dealt, biologically, with a traumatic event (like in PTSD), or with diathesis-stress. If someone wants to spend a bunch of money in psychoanalytic therapy dissecting every time someone hurt their feelings, I guess they can if they have access to that, but they absolutely need EBP to address the thing that might actually kill them first (and things like CBT, ACT, DBT may well address social rejection if it's a repeated or distressing issue for a patient).
 
But mental illness isn't always caused by something like being sightly rejected by peers as a child--sometimes (usually), it's just a bad hand that someone is dealt, biologically, with a traumatic event (like in PTSD), or with diathesis-stress. If someone wants to spend a bunch of money in psychoanalytic therapy dissecting every time someone hurt their feelings, I guess they can if they have access to that, but they absolutely need EBP to address the thing that might actually kill them first (and things like CBT, ACT, DBT may well address social rejection if it's a repeated or distressing issue for a patient).
I completely agree. But how do we go about addressing what it means to “get a bad hand”? It’s not about dissecting every single individual dysfunctional moment in ones life, but to connect individual moments in one’s life to make patterns. Patterns that create bad hands. It’s ultimately a belief in the power of the environment (and the relationships in that environment) to shape somebody, which aligns with behavioral therapy philosophy and values. Like I said before, it’s not either/or.
 
Okay folks I’m signing off for the night. I say a few things:

1. I like this forum. I’m sorry for any malice. I’ve been over smoking cigarettes with the psychiatrists.

2. Friends were over tonight and I had a second dinner beer.

3. Thanks for engaging me, it’s nice we all care a lot.

See you around or tomorrow if anyone wants to continue
 
A. You can’t have a risk factor for something that doesn’t exist. Definitely not possible for some bargain bin therapy approach to cause DID. OSIC said risk for *belieiving* they have DID, which is an important distinction.
B. Then why not just use CBT with some metaphors like everyone does?
"Risk factor" for DID might have been an inexact way to put it, but I think we take the same side on this issue. If IFS is practiced poorly I would worry that it may have an iatrogenic effect, causing a client to believe they have DID.

And yes, I think that at it's best IFS is just CBT with the idea of an internal family as a metaphor. I would agree that CBT with metaphors is the way to go. Again, I think we actually think the same thing. I'm not defending IFS, I'm saying people who like it are trying to make it seem unique when it really isn't.
 
but calling something verifiably untrue without getting more specific is bad form so agree to disagree and leave the truth out of it. Cheers

oo am happy to value the relationship & forum-peace over a difference of opinion but calling something verifiably untrue without getting more specific is bad form so agree to disagree and leave the truth out of it. Cheers

I provided a link to a free resource for to back up my claims and you respond by vacillating between making excuses for yourself and personal attacks. Since you won't access the info for yourself and instead just dig into your own uninformed views, I'll get the info for you:

Multiplicity of the Mind​

IFS views the mind as a dynamic system comprising many subminds, called parts. Freud (1923/1961) opened the door for exploration of multiplicity with his descriptions of the id, ego, and superego. Various post-Freudian theorists have moved beyond his tripartite model and discussed a range of inner entities. Perhaps the most influential of these is object relations theory, which, since Melanie Klein in the 1940s, has asserted that our internal experience is shaped by introjected “objects,” representations of significant people in our lives (Gunthrip, 1971; Klein, 1948).

Jung (1935/1968, 1963, 1968, 1969), in his discussion of archetypes and complexes, took the notion that we contain many minds a step further, considering them as more than just introjects. In 1935, Jung described a complex as having the “tendency to form a little personality of itself. It has a sort of body, a certain amount of its own physiology. It can upset the stomach, it upsets the breathing, it disturbs the heart—in short, it behaves like a partial personality . . . I hold that our personal unconscious… consists of an indefinite, because unknown, number of complexes or fragmentary personalities” (pp. 80–81).

Jung's younger contemporary, Roberto Assagioli (1973, 1965/1975; Ferrucci, 1982), also posited that we are a collection of subpersonalities. Since Assagioli, a large number of theorists have recognized our natural multiplicity; in exploring this territory, they have made observations that are remarkably similar to one another. A more detailed history of the recognition of multiplicity is available in the book Subpersonalities (Rowan, 1990) and the more recent book Multiplicity (Carter, 2008).

Regardless of orientation, most theorists who have explored intrapsychic process have described the mind as having some degree of multiplicity. Scanning the currently influential psychotherapies, we find that object relations describes internal objects (Klein, 1948; Gunthrip, 1971; Fairbairn, 1952; Kernberg, 1976; Winnicott, 1958, 1971); self psychology speaks of grandiose selves versus idealizing selves (Kohut, 1971, 1977); and cognitive-behavioral therapists describe a variety of schemata and possible selves (Dryden & Golden, 1986; Markus & Nurius, 1987; Young Klosko, & Weishaar, 2003). Although these theories vary regarding the degree to which the inner entities are viewed as autonomous and possessing a full complement of emotions and cognitions, as opposed to being interdependent, unidimensional, specialized mental units, they all suggest that the mind is far from unitary.

Theories of psychological trauma theory that undergird the literature on dissociative identitiy disorder (DID) view them as fragments of a potentially unitary personality. Experts on DID recognize the multiplicity of their patients; however, they view these personalities as the result of early trauma and abuse, which forced the person to split off many “alter” personalities (Bliss, 1986; Kluft, 1985; Putnam, 1989; Nijenhuis, Van der Hart, & Steele, 2002).

Regardless of the theorized source of inner entities (learning, trauma, introjection, the collective unconscious, or the mind's natural state), some of these theorists view them as complete personalities. They share a belief that these internal entities are more than clusters of thoughts or feelings, or mere states of mind. Instead, they are seen as distinct personalities, of different ages, temperaments, talents, and even genders, and each with a full range of emotion and desire. The DID theorists hold this view, although they limit it to highly traumatized people. Jung's later writing describes archetypes and complexes in ways that approach full-personality multiplicity, as does a Jungian derivative called voice dialogue (Stone & Winkelman, 1985). In addition, ego state therapy, developed by hypnotherapists John and Helen Watkins (Watkins, 1978; Watkins & Johnson, 1982) and Assagioli's psychosynthesis subscribe to full-personality multiplicity.

Many trauma therapies propose that the existence of subpersonalities is a sign of pathology–a consequence of the fragmentation of the psyche by traumatic experiences. In contrast, like Jung, psychosysnthesis, Ego State Therapy, and Voice Dialogue, the IFS model sees all parts as innately valuable components of a healthy mind. In fact, according to IFS, a fully functioning inner system requires these subminds, each with their different perspectives, talents, and resources, to function well. Trauma does not create these parts, but instead forces many of them out of their naturally valuable functions and healthy states into protective and/or extreme roles and makes them lose trust in the leadership of the Self, which is the undamaged essense of a person that manifests qualities like acceptance, compassion, and clarity. The goal then becomes not to eliminate parts but instead to help them relax into the knowledge that they no longer have to be so protective. The work assists them in realizing that they are no longer under the same level of threat and that there exists a natural inner leader who they can trust. In this way, IFS brings family systems thinking to this internal family, understanding distressed parts in their context, just as family therapists do with problem children, and restoring inner leadership in a way that parallels the creation of secure attachments between parents and children.

IFS distinguishes between two basic categories of parts: protectors and exiles. Exiles are the highly vulnerable, sensitive parts of us that were most hurt by emotional injuries in the past. Because these parts remain frozen in time, still holding the dreadful emotions and beliefs from those experiences, people try to disconnect from them so as to never reexperience the painful emotions and memories they carry–hence the name exiles.

Exiles carry the affect that clients try to regulate through strategies mentioned above like thought suppression, experiential avoidance, and emotional nonacceptance. It is the protector parts that use those strategies and others to control the person's inner environment, internally keeping the person away from the exiles, and to control the person's external world so that the exiles are never triggered by people or events.

Let me know if you need further summary.
 
EMDR, IFS and other popular “therapy” fads and even poorly delivered empirically supported therapies such as DBT by undertrained and unsupervised people is one reason why my schedule is full despite the fact that I don’t take insurance. Bad treatment abounds and makes patients worse and much of my business model is to work with the patients who have experienced this. There seems to be a correlation between how severe the mental illness is and how dangerous bad treatment can be. For the more resilient and mentally healthy people that would likely remit spontaneously without treatment, bad treatment probably is less likely to cause harm. Our patient population are the people with chronic mental illness, not transitory symptoms of psychological distress and these are more desperate for help which also makes them more vulnerable to bad treatment.
 
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