Comparing Internal Family Systems and Cognitive Behavioral Therapy

This post is part one of a two-part series.

Each iteration of mental health treatment is the result of some client being willing to report a treatment’s failure and some clinician being willing to accept negative feedback. Aaron Beck, who developed cognitive behavioral therapy (CBT), had a patient who rejected his proposed Freudian notion that her depression was a product of anger toward someone else redirected toward herself. Instead, she said, she was oppressed by inner criticism. Noting a similar phenomenon in himself, Beck shifted from traditional Freudian views to exploring how positive, rational thought could affect depression and anxiety. In the same vein, Richard Schwartz developed internal family systems (IFS) after discovering that family therapy was insufficient for treating eating disorders.

Currently, CBT is the standard for therapy in many training and treatment programs in the United States. Since I teach IFS, people often ask me how CBT compares. This post looks at some differences and similarities between CBT and IFS in a few key categories.

The Problem to Be Solved

Cognitive behavioral therapy (CBT) asserts that negative thoughts play a big role in depression, anxiety, PTSD, suicidality, addictive processes, and various other behavioral problems. To improve mood, regulate anxiety, and function better, clients are guided to think positively and practice new behaviors.

Internal family systems (IFS) asserts that negative thoughts 1) come from protective parts (or subpersonalities) that inhibit traumatized parts with depression, anxiety, and many other behaviors that have long-term costs, or 2) are expressions of identity (the traumatized parts have depressing, anxiety-provoking beliefs about their worth). From this perspective, improvements in mood and behavior follow from traumatized parts feeling validated, legitimate, and loved.

Goals

CBT and IFS both aim to minimize suffering, maximize effective functioning, and help people feel better. With this in mind:

• The CBT therapist coaches the client to replace irrational thinking and destructive behavior with rational thinking and safe behavior.
• The IFS therapist guides the client to form loving, supportive inner relationships with all of their parts.

Internal Identity and Relationship Narratives

The CBT therapist guides clients to notice and change the stories they tell themselves about their safety, lovability, responsibilities, relationships, and potential.

• CBT therapist: Your goal is to have an active social life. The problem you want to solve is “No one likes me.” If you were to answer that thought, what would you say?

The IFS therapist guides clients to notice and engage with parts who tell verbal and non-verbal (sensory, affective, and cognitive) stories about safety, lovability, responsibilities, relationships, and potential.

• IFS therapist: When you say, “No one likes me,” which part of you is speaking... who is “me”? Does any other part object to you hearing more from this “me” part who feels disliked?

Relationship to Time

All therapy stories have roots in either a personal or a proxy (parental) past, but IFS and CBT relate to time differently.

The CBT client focuses on changing distorted thinking in the present.

The IFS client moves around in time with parts of different ages and experiences.

Motivation

CBT looks for distorted thought patterns that motivate dysfunctional behaviors.

• What were you thinking right before you went into the bar on Monday?

IFS explores the motives of parts.

• Let’s check in with the part who decided to go into that bar on Monday. What does it want you to know?

Identity

In CBT, “I” signifies a singular person (I don’t want to drink, I do want to drink, I don’t know why I drink) whose behavior will change if their thinking and attitude change (I’m not worthless, I’m a competent grown-up).

In IFS, “I” signifies one part out of many. The part who says I don’t want to drink and the part who says I do want to drink are distinct and different. Although both try to solve the problem of another part feeling unlovable and worthless, they do it in opposite ways.

Each solution has short-term merit but ultimately reinforces the underlying feeling of worthlessness. From an IFS perspective, the client will get relief and become less symptomatic when the part who felt worthless feels lovable and loved.

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Treatment

To alleviate depression and anxiety, CBT prioritizes noticing or “tracking” negative thought patterns and beliefs, shifting focus to more realistic, less global, more positive observations and thoughts, and practicing more effective problem-solving.

During the first portion of treatment, IFS prioritizes getting the client into relationship with their parts (and vice versa) by exploring or “tracking” the behavior, motives, and beliefs of the parts that cause trouble (depression, anxiety, excessive disinhibition). Despite the ill effects of their tactics, it’s axiomatic in IFS that extreme parts have good intentions. They are protectors. The client is encouraged to listen to them and offer help.

In the second portion of treatment, the client bears witness to the experiences of exiled parts (who got hurt and were then banished from consciousness by protectors), offers them love and protection, and finally facilitates them in unburdening or letting go of negative identity beliefs and impossible responsibilities.

CBT and IFS diverge most radically around this aspect of treatment. The CBT focus on banishing negative thoughts is anathema to the IFS project of building inner relationships, inviting unpopular protectors to be direct about their fears and meet the client (the kind, concerned, compassionate Self of the client) so they will let the client’s Self help the parts who are in pain.