THE CBT APPROACH
CBT works, but only to a point.
Among many of the therapists I know, CBT, or cognitive behavioral therapy
, gets a bad rap. In spite of ample evidence
to support its efficacy, many of us in the field have had the experience that this evidence doesn’t tell the full story.
I’ve noticed a theme among potential new clients reaching out to my practice. I’ll frequently hear something along the lines of, “I did CBT for years, and it helped for a while, but I still feel like there’s something there that isn’t quite healed.” In my years of experience, I’ve found this same pattern to hold true.
To summarize this treatment modality, CBT makes connections between thoughts, feelings, and behaviors. The central idea to CBT is that thoughts lead to feelings, which lead to behaviors, which often have consequences that reinforce that original thought. CBT therapy attempts to identify and change the thoughts at the root of hurtful patterns. Once the culprit thought has been found, therapists lead clients in exploring other alternative ways of thinking that are more helpful and/or accurate.
Although I’ve found CBT to be useful at the right times, I agree with my clients that it doesn’t quite address the full picture of healing. I’ve even had clients tell me that they feel like they need to undo years of damage from CBT, which they’ve felt has taught them to shut down their feelings. To fully understand ourselves, we need to explore how those thought patterns came to be in the first place.
Real healing needs to go deeper.
Integrating CBT with Internal Family Systems
therapy, or IFS, can succeed in going to those deeper places.
THE IFS APPROACH
The IFS approach suggests that we all have internal “parts” that play different roles for us, interact with one another, and help us to be embodied in our lives. When parts are burdened by inappropriate roles, beliefs, or traumas, they tend to fall into categories of protectors and exiles. IFS works to “unburden” our parts and grow “self-leadership.”
When I refer to “self-leadership,” I am talking about what IFS calls the “Self.” In addition to our parts, at our core, we all possess an internal “Self,” which is connected to a greater energy that binds us all. “Self-energy” is inherently compassionate, wise, confident, curious, and clear. The Self is the natural leader of our internal systems, and IFS works to bring the Self solidly into that role.
When we talk about real healing, we need to explore the deep roots of whatever we are experiencing now. Beyond identifying maladaptive beliefs, we need to explore where these beliefs originated, and work to heal those wounds. With an IFS lens, we can assume that the parts that hold limiting beliefs have good reasons behind that, so we need to connect with them and learn from them before telling them to be quiet and that they’re wrong.
SAFETY AND INTEGRATION
For many years, I also did my fair share of hating on CBT. I’ve often felt that the CBT approach could be summed up as “talking yourself out of it,” which, to me, feels dismissive and incomplete. However, in recent years, I’ve begun to appreciate CBT when it’s used with an IFS approach. In fact, I think CBT can be the key to really moving into an empowered place in the “integration stage” of trauma healing. It can also be an essential tool for establishing safety in the early stages of the work.
In her essential book, Trauma and Recovery
, Judith Herman talks about trauma recovery in three stages: safety, processing, and integration. In the safety stage, it’s important to develop tools to help clients to stay within and widen their Window of Tolerance
, to be able to ground, and to function in daily life. Getting control of overwhelming negative thoughts using CBT can be helpful in this stage.
CBT can also be helpful after trauma has been processed (which can happen in a variety of ways, including IFS and EMDR
), as a way to integrate what’s been learned into a new way of living. This can look like strengthening empowering beliefs through a CBT approach.
My take is that the big mistake that clinicians make with CBT is to treat it as a modality that can be used in isolation without combining it with more holistic approaches. The problem with using CBT as an isolated approach is that it completely skips the processing stage of healing. Pairing IFS with CBT can help to bridge that gap.
TRUST AND INTEGRITY
A central tenet to IFS is that there are “no bad parts
.” In this work, we assume that all parts have good intentions, and only want the best for us. The problem is that sometimes, the “best” is just survival, based on parts' limited perspective.
In my work, I’ve found upon really getting to know a client's parts that they often have very good reasons for thinking what they think and behaving in the ways that they do. Most often, these ways of thinking and behaving developed during a time when they were actually protective and useful, given the limitations of childhood.
Parts are most often young, and tend to get stuck in the past. The key is to bring them into the present day, and help them to form a trusting relationship with the Self. The Self can become the internal parent to this system, so parts don’t have to keep doing what worked then, but doesn’t function anymore.
THE TRUSTED INTERNAL PARENT
Over time, I've noticed that CBT works remarkably well after establishing a secure internal relationship between core “Self” and “parts.” The key is establishing trust. When we think about authority, trust is a crucial component to legitimacy and safety. This is the difference between doing CBT from a place of integration vs. bossing yourself around.
Think of it this way - you can receive the same instructions from two different sources and have them land completely differently. For example, if you have an authoritarian tennis coach that picks favorites and shows up late, you may still run when he tells you to run, but you’ll go about it with resentment. You may not give it your best effort, you’ll grumble along the way, and eventually you may even quit the team. By contrast, if you have a coach that shows up with integrity and that you trust to have your best interests at heart, you will give your best to whatever you’re asked to do, trusting that you’re being cared for and guided with love.
It's the same with our internal parts. When our parts feel like we’re listening, like we really understand their concerns, and like we’re trustworthy and equipped to run the show, they will be more willing to listen when we ask them to shift their perspective. If we try to force the issue, we may have some success on the front end, but without doing the work of processing, parts will either continue to pipe up around the edges, or our pain will get buried even more deeply than before.
If you think about IFS as a real internal family, you can compare dealing with parts to how you might deal with children or teens. Some kids will need a lot of space and grace, while others will need a firm hand. Still others will need both, at different times. When trust is there, it can actually be soothing and empowering to have an authority figure tell us “it’s ok, calm down,” to remind us to hold our heads high instead of wallowing, or to tell us to be brave and step into the unknown.
The crucial pieces here are trust, and leaving room for feelings. After parts have really been heard, and can trust that we see and appreciate their experience, they’ll be open to the internal regulation that can come from simply making a choice to think differently.
DONT SKIP THE PROCESSING
To sum it up, CBT is a tool, not a cure. If something is happening for us, it deserves exploration, and we cannot skip that step. But once we’ve put in that time with curiosity and care, CBT can be that firm and confident voice of authority that helps us step into a new mindset. Thinking differently is incredibly powerful, and can take us to new levels in so many ways. But we mustn’t skip the step of real healing and listening. Our parts all have something to share.