Frances Booth LICSW
To conduct a proof-of-concept randomized trial of an Internal Family Systems (IFS) psychotherapeutic intervention on rheumatoid arthritis (RA) disease activity and psychological status.
Patients with RA were randomized to either an IFS group for 9 months (n = 39) or an education (control) group (n = 40) that received mailed materials on RA symptoms and management. The groups were evaluated every 3 months until intervention end and 1 year later. Self-assessed joint pain (RA Disease Activity Index joint score), Short Form-12 physical function score, visual analog scale for overall pain and mental health status (Beck Depression Inventory, and State Trait Anxiety Inventory) were assessed. The 28-joint Disease Activity Score-C-reactive Protein 4 was determined by rheumatologists blinded to group assignment. Treatment effects were estimated by between-group differences, and mixed model repeated measures compared trends between study arms at 9 months and 1 year after intervention end.
RESULTS:Of 79 participants randomized, 68 completed the study assessments and 82% of the IFS group completed the protocol. Posttreatment improvements favoring the IFS group occurred in overall pain [mean treatment effects -14.9 (29.1 SD); p = 0.04], and physical function [14.6 (25.3); p = 0.04]. Posttreatment improvements were sustained 1 year later in self-assessed joint pain [-0.6 (1.1); p = 0.04], self-compassion [1.8 (2.8); p = 0.01], and depressive symptoms [-3.2 (5.0); p =0.01]. There were no sustained improvements in anxiety, self-efficacy, or disease activity
An IFS-based intervention is feasible and acceptable to patients with RA and may complement medical management of the disease. Future efficacy trials are warranted. ClinicalTrials.gov identifier: NCT00869349.
[Go to: http://www.ncbi.nlm.nih.gov/pubmed/23950186 to read more.]
J Rheumatol. 2013 Nov;40(11):1831-41. doi: 10.3899/jrheum.121465. Epub 2013 Aug 15.
Shadick NA1, Sowell NF, Frits ML, Hoffman SM, Hartz SA, Booth FD, Sweezy M, Rogers PR, Dubin RL, Atkinson JC, Friedman AL, Augusto F, Iannaccone CK, Fossel AH, Quinn G, Cui J, Losina E, Schwartz RC.
Albert Schweitzer said: Each patient carries his own doctor inside him. They come to us not knowing that truth. We are at our best when we give the doctor who resides within each patient a chance to work. This wisdom is a core tenet in a relatively new model of therapy, Internal Family Systems. Richard Schwartz, founder of Internal Family Systems, calls this doctor inside each of us “Self.” The elegance of this new model is that it integrates the experience and use of “Self” with a variety of familiar theoretical frameworks and clinical interventions.
Internal Family Systems (IFS) originated by applying concepts from family systems theory and practice to the inner world. IFS views the multiplicity of the mind as our natural state. Defenses, symptoms and behaviors are “parts” of the inner world that exist and operate like the roles and alliances of individuals within families, carrying their own burdens, missions, and having complex relationships between themselves. The intensity of inner tension decreases as one understands the parts’ origins and roles. Then the innate compassion, curiosity and calm that lies within each of us is released and the inner resources of perspective, courage, and creativity are available to facilitate healing.
The IFS paradigm offers clear techniques to establish a collaborative therapeutic relationship; to develop genuine appreciation for the protective function of defenses; to integrate somatic experience, and to resource qualities of resilience. In practice, there is an unequivocal emphasis on the client’s relationship with their inner world and the formation of a connection with the inner world’s “parts” as treasured friends. As my comfort using the model grows, I more easily relax my own defenses to deepen the therapeutic container created in the office. I regularly experience a profound, felt sense of compassion for myself and others. I more readily “see” the core pain and vulnerability a client carries. The theory and practice of IFS has deepened my ability to “see” the heart of the matter.
I have found the model helpful for a wide range of clinical presentations, in particular for my clients struggling with trauma, eating disorders, cancer and for those who experienced childhood neglect and abandonment. Clinicians comfortable in intrapsychic, relational, Jungian, Gestalt, psychosynthesis, family systems, and/or attachment theory will discover much that is familiar. Those of you who have studied EMDR, sensorimotor, somatic-experiencing, psychodrama, hypnosis, focusing, and/or narrative therapy will easily weave your current practices within this comprehensive conceptual framework. If you are exploring the integration of mindfulness and psychotherapy, IFS will resonate with you as well.
I will further present on Internal Family Systems, both theory and practice, at our NASW Social Work Symposium, Thursday morning, April 10, 2008. I look forward to seeing you and speaking with you about the “Heart of the Matter”.
Published in Massachusetts NASW Focus, Spring, 2008