Rehab Kids

Treating Complex
Trauma with Internal
Family Systems (IFS)
2-Day Intensive Workshop
Frank Guastella Anderson, MD

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 Treating Complex
Trauma with Internal
Family Systems (IFS)
2-Day Intensive Workshop
Frank Guastella Anderson, MD

Rehab Kids

ZNM053540
6/22
Copyright © 2022

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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 the vice chair and director of the Foundation

for Self Leadership. He is a trainer at IFS Institute with Richard
Schwartz, PhD, and maintains a long affiliation with, and trains
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 wrote the chapter “Who’s Taking
What” Connecting Neuroscience, Psychopharmacology and
Internal Family Systems for Trauma in Internal Family Systems
Therapy-New Dimensions. He co-authored a chapter on “What
IFS Brings to Trauma Treatment in Innovations and Elaborations
in Internal Family Systems Therapy” and recently coauthored the
Internal Family Systems Skills Training Manual.

Dr. Anderson maintains a private practice in Concord, MA, and

serves as an advisor to the International Association of Trauma
Professionals (IATP).

For speaker disclosures, please see the faculty biography in activity advertising.

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.
As required by several accrediting boards, speaker and
activity planning committee conflicts of interest
(including financial relationships with ineligible
organizations) were disclosed prior to the start of this
activity. To view disclosure information, please see
activity advertising.
 Internal Family Systems (IFS):
Treating Complex or
1 Relational Trauma
Frank Anderson, MD
Website = FrankAndersonMD.com
@2020 Frank G. Anderson MD, all rights reserved

2
Opening Meditation

@2020 Frank G. Anderson MD, all rights reserved

1
3 Treating Complex Trauma
 Look at the different types of trauma & phase oriented
treatment
 Compare different trauma treatments,
 Working with parts of self, dealing with traumatic overwhelm
 Explore therapists parts and clients inner healing capacity
 Empathy vs. Compassion
 Dealing with Attachment Trauma
 Neurobiology of PTSD and Dissociation
 How Neuroscience helps inform therapeutic decisions
 The healing process and the science behind it.
@2020 Frank G. Anderson MD, all rights reserved

Complex Trauma at it’s Core

4
is a Relational Violation
Working with it, activates our relationship
histories and personal wounds as well as
challenges our struggles with closeness and
intimacy.

@2020 Frank G. Anderson MD, all rights reserved

2
5 What is Challenging about Treating
Complex Trauma?
 The Extreme reactions commonly associated with it
 From desperation for connection to total rejection.
 From to cutting to suicide, from shame to dissociation.
 The Attachment issues that get activated with it
 Disorganized, anxious, avoidant
 The Boundary Issues that get stirred up
 Too much or too little.
 The Co-morbidities associated with it.
 Depression, anxiety, eating issues, substance abuse etc.
 The Countertransference issues that get stirred up in therapist’s
 Healing the violation of trust in relationship while engaging in a relationship.

@2020 Frank G. Anderson MD, all rights reserved

6 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)

@2020 Frank G. Anderson MD, all rights reserved

3
7 Acute vs. Chronic PTSD
 Acute trauma
 Symptoms resolve with in 1 month.
 Most have experienced this (70%) e.g. car accident
 Meds for acute trauma
 PTSD
 Symptoms from trauma remain after 1 month (20%)
Re-experiencing or reliving the event
Avoidance of situations that remind you of the trauma
Negative beliefs or feelings about yourself
Hyperarousal
@2020 Frank G. Anderson MD, all rights reserved

8 Complex, Interpersonal or Relational Trauma

 Harm or abandonment by a caregiver or other personal

relationship. Childhood or adulthood.
 DESNOS = Disorders of Extreme Stress (van der Kolk)
Problems with:
Regulation of affect and impulses.
Memory and attention
Self-Perception
Interpersonal Relations
Somatization
Systems of meaning
@2020 Frank G. Anderson MD, all rights reserved

4
 9 Developmental Trauma
 Trauma that occurs during various developmental
stages.
 The impact these experiences have on brain
development, symptom production and psychiatric
disorders (Martin Teicher, MD, PhD)
 Timing of exposure and sensitive periods are key.
 Bruce Perry-Neurosequential Model
 Adverse Childhood Experience (A.C.E score)
Number of exposures vs. severity
Emotional, physical or contact sexual abuse along
with 5 categories of household dysfunction.

@2020 Frank G. Anderson MD, all rights reserved

10 Extreme or Dissociative Trauma

Dissociation as a Spectrum Disorder

We all dissociate to some degree
PTSD has dissociation as a component
The Extreme end = DID

@2020 Frank G. Anderson MD, all rights reserved

5
11 Phase Oriented Treatment for PTSD and Dissociation

 The gold standard

 Phase 1
 Increase safety & competencies
 Decrease symptoms
 Phase 2
 Processing trauma memories
 Review and re-appraise
 Phase 3
 Consolidate, integrate & rehabilitate
@2020 Frank G. Anderson MD, all rights reserved

12 Why Not Phase Oriented Treatment?

Can give extreme parts the wrong message

Clients do have within them the capacity to heal,
it doesn’t need to be cultivated
There is another way to deal with the overwhelm
other than building resources

@2020 Frank G. Anderson MD, all rights reserved

6
13 Experiential Treatments for Complex Trauma

 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

@2020 Frank G. Anderson MD, all rights reserved

14 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
@2020 Frank G. Anderson MD, all rights reserved

7
15
What’s Important for Healing

Mindful Separation
(Unblending)
Self vs. Building Resources
Permission vs. Stabilization
Therapeutic Relationship (TR)
Healing at the Core
@2020 Frank G. Anderson MD, all rights reserved

16 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
 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.
@2020 Frank G. Anderson MD, all rights reserved

8
17 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
Cognitive impairment
@2020 Frank G. Anderson MD, all rights reserved

18 Parts
 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)
@2020 Frank G. Anderson MD, all rights reserved

9
19 Protective Parts

Trying to protect us from being hurt again

Keep wounds exiled

2 kinds of protectors parts

Prevent the pain (manager)
Stop the pain (firefighter)

@2020 Frank G. Anderson MD, all rights reserved

20 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.
@2020 Frank G. Anderson MD, all rights reserved

10
 Getting to know a
21
preventative part.

@2020 Frank G. Anderson MD, all rights reserved

22 Stop the Pain

React when the wound has been

activated
Try to “put out the fire”
Extreme in their response
Examples
Binging, purging, cutting, suicidal
thoughts, substance abuse, numbing
out, dissociating

@2020 Frank G. Anderson MD, all rights reserved

11
23 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

@2020 Frank G. Anderson MD, all rights reserved

Video
24
“All the little voices in our heads”

@2020 Frank G. Anderson MD, all rights reserved

12
25 IFS Complex Trauma Study

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@2020 Frank G. Anderson MD, all rights reserved

26 Graph for PTSD (CAPS) Reduction




















 
 






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@2020 Frank G. Anderson MD, all rights reserved

13
27 Graph for Depression (BDI) Reduction












   
 






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@2020 Frank G. Anderson MD, all rights reserved

28 Rheumatoid Arthritis Study and IFS

 IFS became Evidence-Based 2014 NREPP under SAMHSA
 Study in the Journal of Rheumatology
 Randomized trail- 70 patients- 36 weeks of treatment - 1
year follow-up
 Shown Effective in general functioning and well- being
 Promising with phobia, panic and generalized anxiety
Physical health conditions
Personal resilience and self concept
Depression
@2020 Frank G. Anderson MD, all rights reserved

14
29 Rheumatoid Arthritis Study and IFS
 IFS became Evidence-Based 2014 NREPP under SAMHSA
 Study in the Journal of Rheumatology
 Randomized trail- 70 patients- 36 weeks of treatment - 1
year follow-up
 Shown Effective in general functioning and well- being
 Promising with phobia, panic and generalized anxiety
Physical health conditions
Personal resilience and self concept
Depression
@2020 Frank G. Anderson MD, all rights reserved

How IFS Handles Diagnoses & Co-

30
morbidities

@2020 Frank G. Anderson MD, all rights reserved

15
 Diagnoses Redefined
31
“She is such a Borderline”

@2020 Frank G. Anderson MD, all rights reserved

32 A Non-Pathological Approach
 Borderline Personality Disorder
 I don’t believe in it
BPD = Trauma History
 Attachment Disorders (i.e. Disorganized
Attachment, Avoidant, Anxious)
Nothing disorganized about it, (Polarization)
The Avoidant or Anxious Part
 DID
Protector-protector battles to keep the
vulnerability away. It’s very effective!
@2020 Frank G. Anderson MD, all rights reserved

16
33 Psychology vs. Biology
How IFS Handles Biological Processes
 Real Mind Body Medicine
 Differentiate a Therapeutic Issue from a Biological
Process
 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.
 How to differentiate?
@2020 Frank G. Anderson MD, all rights reserved

34 Part vs. Symptom

 Depression
 Plexiglas vs. No dating
 Anxiety
 Part that worries or are the serotonin levels low?
 Alcohol Abuse
 The part that drinks to protect (the little girl)
 The physiological addiction or the habit
 Cravings or withdrawal

 Bipolar Disorder
 The part that flees with mania and/or depression
 A genetic transmission
 I never met a person with Bipolar that didn’t have a trauma history
 Again, Parts will tell you if you ask!
@2020 Frank G. Anderson MD, all rights reserved

17
35 Self Energy
Different from parts

Healing capacity

Core or seat of consciousness

Spiritual Space for some

All living things are made up of energy

@2020 Frank G. Anderson MD, all rights reserved

36 Qualities of Self (8 C’s)

Curious Courage
Calm Creative
Confident Connected
Compassion Clarity
@2020 Frank G. Anderson MD, all rights reserved

18
37 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)

@2020 Frank G. Anderson MD, all rights reserved

38 Healing from the Inside and Out

 We can heal relational wounds internally between

the Self and the wounded part of the individual
utilizing both Empathy and Compassion

 We can heal relational wounds externally also

between the Self and the wound of the client while
they are in connection with the Self of the other
utilizing Empathy and Compassion within both
parties.

Wounds often need both from both.

@2020 Frank G. Anderson MD, all rights reserved

19
 The Steps of the Model:
39
Working with Protective Parts

@2020 Frank G. Anderson MD, all rights reserved

40 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
@2020 Frank G. Anderson MD, all rights reserved

20
 “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
41
permission to access the wound.”

@2020 Frank G. Anderson MD, all rights reserved

42 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 Its Fear
@2020 Frank G. Anderson MD, all rights reserved

21
43 The First 3 F’s
Identifying the Part & Separating it from the Self

 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

@2020 Frank G. Anderson MD, all rights reserved

44
Identifying Parts Video (1)

@2020 Frank G. Anderson MD, all rights reserved

22
45 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
@2020 Frank G. Anderson MD, all rights reserved

46
Video-Self Energy

@2020 Frank G. Anderson MD, all rights reserved

23
47 The 5th F
Be-Friending the Part
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
The goal is to get it’s permission to access the
wound

@2020 Frank G. Anderson MD, all rights reserved

48 The 6th F
Find Out It’s Job and 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.

@2020 Frank G. Anderson MD, all rights reserved

24
49 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
@2020 Frank G. Anderson MD, all rights reserved

50 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…

@2020 Frank G. Anderson MD, all rights reserved











25
51 Introducing the Part to the Self
 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?
 Internal Attachment Work
 Develop a trusting relationship between the Self & Part
 We are repairing a rupture, apology
 Watch for caretaking parts in the therapist

@2020 Frank G. Anderson MD, all rights reserved

52 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.

@2020 Frank G. Anderson MD, all rights reserved

26
53 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 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
@2020 Frank G. Anderson MD, all rights reserved

Video
54
*Anxious-Direct Access- Invitation

@2020 Frank G. Anderson MD, all rights reserved

27
55 Summary- The Goal of Working with Protectors

We help the part separate (unblend)

We Introduce the Part to the Self
We Learn about it’s job and fear
We help it deal with the overwhelm
We get it’s permission to heal the
wound.

@2020 Frank G. Anderson MD, all rights reserved

The Science Behind

Find, Focus, Flesh Out & Feel Toward
56

@2020 Frank G. Anderson MD, all rights reserved

28
57
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
@2020 Frank G. Anderson MD, all rights reserved

58 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
@2020 Frank G. Anderson MD, all rights reserved

29
 Neurons to Networks
59

@2020 Frank G. Anderson MD, all rights reserved

The Nervous System Beyond the Brain

60

@2020 Frank G. Anderson MD, all rights reserved

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61 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
@2020 Frank G. Anderson MD, all rights reserved

Horizontal (right-left) Network

62

Left Right
Hemisphere Hemisphere
Linguistic, Physical,
Logical, Emotional
Factual, Unconscious
Conscious
Connects to
Connects to
Hippocampus
Limbic,
Brainstem &
Body
Bo

@2020 Frank G. Anderson MD, all rights reserved

31
 Vertical Network
63

Medial Prefrontal
Cortex,

 Anterior
Cingulate
& Insula

Right
Hemisphere

Limbic
(amygdala,
hippocampus,
hypothalamus)

Brainstem &
Thalamus

Body




@2020 Frank G. Anderson MD, all rights reserved

64 Large Scale Networks (Bressler and Menon)

 Default Mode Network (DMN)
 Spontaneous mind wondering and
internal self talk
 “brain at rest”
 Salience Network DMN
 Controller or network switcher
 Turns on or off the DMN and CEN Salience
 Central Executive Network (CEN) Network
 Higher order cognitive (working
memory) & attentional control,
(conscious brain)

*Poor synchronization between above CEN

implicated in Alzheimer’s, schizophrenia,
autism, bipolar & PTSD
*Rhythm based therapies may repair

@2020 Frank G. Anderson MD, all rights reserved

32
65 Primary Process 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
@2020 Frank G. Anderson MD, all rights reserved

66
Symptoms = Mind & Brain = Parts

Large percentage 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.”
@2020 Frank G. Anderson MD, all rights reserved

33
67 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
@2020 Frank G. Anderson MD, all rights reserved

68 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)

@2020 Frank G. Anderson MD, all rights reserved

34
 Cortical Midline Structures (CMS)
69
(Nortoff & Bermpohl)

 Generating a model of the Self in the brain

 Processing of Self-referential stimuli in CMS

OMPFC= How we Represent ourselves.
DLPFC= How we Evaluate ourselves.
AC= How we Monitor ourselves.
PC= Helps Integrate the above.

 Connects to dorsal & ventral lateral PFC, which serve

hippocampus, amygdala & insula
 (Self, Emotion & Body awareness)
@2020 Frank G. Anderson MD, all rights reserved

70 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.

@2020 Frank G. Anderson MD, all rights reserved

35
71
Attachment Disorders and Trauma

@2020 Frank G. Anderson MD, all rights reserved

Connection is Important!
72
Social Baseline Theory (SBT) (James A. Coan)
 Brains response less to threat with good relationships
 Hand Holding with good quality partner
 strongly diminished threat-related activations throughout the brain,
including the right anterior insula, hypothalamus, and dorsolateral
prefrontal cortex.
 Lower quality partner
 Rt. anterior insula, superior frontal gyrus, & hypothalamus with increased
stress hormones
 Stranger
 Above plus- superior colliculus, right dorsolateral PFC, caudate and
nucleus accumbens (vigilance)
 Alone
 Above plus- ventral ACC, posterior cingulate, supramarginal gyrus, and
postcentral gyrus
@2020 Frank G. Anderson MD, all rights reserved

36
73 Social Regulation to Threat (James A. Coan)
 We recruit more brain structures with more threat
 Self-regulation is top down, cognitive & attentional (PFC)
 Using the gas & the breaks at the same time

 Relationships conserve energy with threat

 Bottom-up process (subcortical)

 Research study- Can Self energy do the same internally as good

quality relationships do externally???

@2020 Frank G. Anderson MD, all rights reserved

74 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.

@2020 Frank G. Anderson MD, all rights reserved

37
75
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!

@2020 Frank G. Anderson MD, all rights reserved

76 Attachment Theory & IFS

 No one is any one style

 Attachment styles are protective parts of child
connecting to different parts of the caregiver.
Secure vs. Parts not triggered- balanced
state
Avoidant vs. Blunted protective part of child
Anxious vs. Activated protective part of child
Disorganized vs. Protector & Exile Polarized

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77 IFS and Attachment Trauma
An Internal Attachment Model
External vs. internal relationship as curative?
Therapist as an adjunct- The Self as the primary
Young attachment wounds make most of our
relationship decisions
What are we really offering?
Self as the healing agent vs. the corrective
experience?

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78 IFS and Relational Trauma

Countertransference Redefined
Therapists parts- healing our own wounds
“Self Lead” Boundaries
Therapist caretaking (giving too much)
Therapist controlling (managing the intensity)
Achieving separation with attachment issues
Dealing with Preverbal trauma
Parts communicate in any form

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79 IFS and Relational Trauma
Loss & Letting Go
Traumatic loss, holding on, hoarding
Caretaking parts
Giving to others what you wanted and never really had
 Critical and Substance using protectors
Preventing the pain by behaving & numbing with drugs &
food
Passive, victimized parts
We often feel them but don’t name them
Clients live a lot of their life from these parts

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80 Growing Up with the Lack of Connection

Neglect
Tenacious, slow going
The absence of something
Filling in with thoughts and thinking
Work with body sensations as an entry point.

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40
81 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.

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The Vertical Network and Fear (extinction)

82
(Ledoux)

OMPFC

AC

(LA)
NE, 5HT, DA
(CE)

Thalamus Amygdala

Hypothalamus

Hippocampus
Brainstem
Sensory ANS,
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83
Naming Extreme Responses

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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
84 Ventral and Dorsal Branches

Three Categories of Extreme Reactions

1. Activation or Hyper-aroused
2. Blunted or Hypo-aroused
3. Wounds
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85 Implicit memory

Begins in the first 18 months of life.

Perception, emotion, bodily sensation
Doesn’t feel as if coming from the past
Tenacious, unconscious
No hippocampal involvement
Body, brainstem & right hemisphere

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86 Explicit Memory
2 years and beyond
Requires focused attention (DLPFC)
Factual, episodic, linear
Brings into awareness the past
Sense of time, helps create narrative
Conscious
Requires Hippocampus

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87  
 

 


 






 
  







 


  























 







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88 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,
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89 Extreme Parts- Activation
(Lanius) imaging studies, chronic child abuse

Hyper-aroused,
reactive,
sympathetic

Low activation
of mPFC & AC,
High insula

Failed inhibition,
High emotion
High sensations
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Therapist’s Parts
90
What get’s activated in you?

Experiential exercise
Hyper-aroused parts

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45
91 How Science Informs Decisions with
Hyper-aroused Parts

Failed cortical inhibition

Goal- to bring the prefrontal cortex back
on-line
(PFC-integrates attention, emotion &
memory)
“Be the auxiliary brain”
Compassion not Empathy

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92 How Science Informs Decisions with

Hyper-aroused Parts
 Provide Structure and perspective
 Therapist needs to be calm, steady & non-reactive
 Help put feeling into words, sooth physical & emotional activation.
 “Help make sense out of things”

 Top-Down Strategies to Unblend

 Don’t focus on activation (energy gets energy)
 Don’t get “too relational” or try to connect

 Self of the therapist needs to meet the largest part

 “Courageous confrontation”
 At home strategies
 Don’t make decisions, read, check email, change states
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93 When Separation Is Not Possible

“Being the Auxiliary Brain”

(PFC-integrates attention, emotion &
memory)
Talk directly to it
Learn what it is trying to accomplish
Ultimately to get permission to heal the
wound

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Video
94
Suicidal Part

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95 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
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Prefrontal
cortex
Hippocampus

Amygdala
Thalamus Ventral
(Lateral to basal) Striatum

Threat to
body Escape and
avoidance

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97 Extreme Parts- Blunting
(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
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Therapist’s Parts
98 What get’s activated in you?

Experiential exercise
Hypo-aroused parts

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 99 How Science Informs Decisions with Blunting

 Move from Dorsal to Ventral branch

 First Assess where your client is at;

 Can you look at me, Can you talk, Can you take a breathe?
Can you move your finger?

 Don’t talk about it!

 Bring feelings & body sensations back online.

 Foster nurturance and connection

 “Sense” things (Empathy not Compassion)

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100 How Science Informs Decisions with Blunting

Bottom-up strategies
 Dealing with underwhelm. Slow it way down!
 The more you push the harder they run.
 “You’re the boss. Take as much time as you need.”
 Blunting takes longer to recover from.
 Hand over control & trust.
 Build connection from the bottom up.
 Body first, then emotions then thoughts
 How far away is the part in distance?
 Can it move in closer slowly
 At home- Exercise, listen to music, have sex, watch a favorite movie.
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101 When Separation Is Not Possible

Again be the “Auxiliary Brain”

(Ventral PNS is connection without threat)

Talk Directly to numbing, shame etc.

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102 Summary-Reactive & Preventive Parts

High Low Left Brain

Arousal Arousal arousal

Cognitive
Dorsal
Sympathetic parasympathetic
anxiety, worry,
apprehension

Neglect, shame,
Fight-flight freeze,
dissociation Manager
Danger
Life threatening

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51
 Video
(Scan-Ignore Part- Direct Access- Self- Invitation)
103

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104 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
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105 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 comes up with a solution to the problem
Not the therapist

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106 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 preventive and reactive parts
 Learning about alliances helps you get to know about
the system and how the system works

@2020 Frank G. Anderson MD, all rights reserved

53
 How IFS Handles Healing:
The Unburdening Process
107

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108
Video
SYTYCD

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54
109
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

@2020 Frank G. Anderson MD, all rights reserved

110 Unburdening Process

 With presence of Self Energy (client & therapist)
 After protective parts have given access/permission

 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
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111 Legacy Burdens
 We all carry Legacy burdens
 Culture, gender, ethnic, race
 The gifts and the burdens of legacy
 They often block healing in trauma
 Check the % that belongs to the client and the % that is
not theirs and can be released
 Address loyalty issues
 We each have our own paths
 Call in the Self of the parent

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112 The Post Unburdening Process

 Have client 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

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113 Trauma Memories and
Forgiveness

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The Science Behind Emotional Healing

114











57
115
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)
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116 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.

@2020 Frank G. Anderson MD, all rights reserved

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117
Unburdening Video
Start at 11 min stop at 29:14 restart at 36:20

@2020 Frank G. Anderson MD, all rights reserved

118
Thank you

@2020 Frank G. Anderson MD, all rights reserved

59
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NOTES
NOTES