IFS Based

Internal Family Systems and Ego States Interventions Note: Presenting Issues: - Patient, Sarah J., a 34-year-old female, presented with chronic anxiety, panic attacks, and difficulty forming lasting relationships. She described a pervasive feeling of not being ‘enough’ and a fear of abandonment, exacerbated by recent professional setbacks and a breakup. She reported these feelings have been present since adolescence, with increasing intensity over the past two years. Past History and Noted Progress: - History of childhood emotional neglect and a physically absent father. Previous CBT and psychodynamic therapy provided some coping strategies but did not address core self-worth issues. She reports periods of stability followed by acute crises. No significant progress noted in previous therapies regarding her core fear of abandonment. Medications: - Currently taking Sertraline 50mg daily for anxiety (initiated 6 months ago) and occasionally uses propranolol 10mg as needed for panic attacks. No supplements mentioned. Social History: - Lives alone. Limited close friendships, often feeling misunderstood. Reports a strained relationship with her mother, who is critical and emotionally distant. No significant support system currently in place. Recently ended a 2-year relationship due to her fears of intimacy. Trauma-Informed and Attachment Based Assessment: - Patient's current anxiety and relationship patterns are strongly indicative of insecure attachment, likely avoidant-fearful, stemming from early childhood experiences of emotional unavailability. Her chronic feelings of inadequacy and fear of abandonment align with complex trauma responses, where past relational wounds are re-activated in current social contexts. Her difficulty trusting others and her self-critical inner dialogue are protective mechanisms developed in response to perceived threats to her emotional safety. EMDR - Not utilised in this session. Internal Family Systems (IFS) Assessment: - Identified a 'Perfectionist' part driven by fear of failure and criticism, often taking over when faced with challenges. This part pushes her to overwork and constantly seek external validation. - A 'Self-Critic' part was also identified, constantly berating her for perceived mistakes and reinforcing feelings of inadequacy. Its function appears to be to keep her 'safe' by preventing her from taking risks that might lead to further hurt or rejection. - An 'Exiled Child' part, holding deep feelings of loneliness, worthlessness, and abandonment from early childhood experiences. This part is often triggered by relational difficulties or perceived rejections, leading to intense emotional dysregulation. Ego States Assessment: - Dominant 'Adult-Critical Parent' ego state often leads with judgment and self-reprimand, aligning with the IFS 'Self-Critic' part. This state dictates her internal dialogue and drives her decision-making process, often leading to self-sabotage. - A 'Vulnerable Child' ego state emerges during moments of intense anxiety or perceived threat, characterised by helplessness and a strong desire for external comfort. This state is often suppressed but manifests as panic attacks. - A 'Rebellious Adolescent' ego state was briefly identified, expressed through passive-aggressive tendencies in relationships, stemming from a desire for control in situations where she feels powerless. Interventions: - Initiated unblending exercise with the 'Perfectionist' part, encouraging the patient to observe it with curiosity rather than identification. Patient was guided to ask the part what it was afraid would happen if it relaxed its control. - Engaged in a dialogue with the 'Self-Critic' ego state, asking about its positive intention, which was revealed to be protecting the patient from further pain. Negotiation began by exploring less harsh ways to achieve this protection. - Assigned homework: Daily 5-minute mindfulness exercise to notice inner voices without judgment, and to journal instances where the 'Perfectionist' or 'Self-Critic' parts become active. Progress and Response: - Patient demonstrated a nascent ability to differentiate from the 'Perfectionist' part, expressing surprise at its underlying fear. She reported feeling a slight shift in perspective, moving from being consumed by self-criticism to observing it. However, she found it challenging to fully access the compassionate 'Self' during the session. - Minor resistance was noted when exploring the possibility of less harsh self-talk, indicating the deep-seated nature of the 'Self-Critic' state. Plan: - Future sessions will focus on further unblending from protective parts and exploring the needs and burdens of the 'Exiled Child' part through guided imagery and 'Self'-led witnessing. Continue dialogue with the 'Self-Critic' to negotiate new roles. - Referrals to local mindfulness groups will be provided to support daily practice. Goal is to increase 'Self' energy and create internal harmony by 1 November 2024.