Hospitals, clinics, and addiction treatment programs have standard assessment forms that clients fill out in the context of a larger process called an intake evaluation. A staff member or trainee walks the client through the assessment questions to get as much factual information about them and their history as possible. The interviewer is a stranger and an evaluative authority figure who the client may never see again.
We have a bone to pick with this approach. A fact-finding interview with a narrow line of questioning (which coaxes tell-tale information about self-destructive behavior in excruciating detail) summons a fragile, shamed person to the punitive court of self-judgment. It’s intrusive and it establishes a hierarchical relationship that can easily evoke fear and defensiveness. It also fails to explore the ways in which the client is productive and tells us little about how they are navigating inner conflict, which is a crucial feature of addictive processes. The standard assessment approach puts the interviewer in a one-up manager position with authority over the one-down, troubled client and is a disservice to both parties. In these ways, it is antithetical to the IFS approach.
In our first therapy session with a client, we are careful not to start by urging them to expose their most shame-inducing secrets. Just like the client and the interviewer in a standard assessment, the client and the therapist are initially strangers to each other. Therefore, in IFS therapy, our first aim is to create a safe, collaborative context. We view assessment as a process that occurs over time. Instead of launching into an investigation, we get curious, avoid assumptions, and ask a lot of open-ended questions— and we continue in this vein in every session thereafter. We learn the client’s history and assess their functioning over time. We understand that larger institutions create standard criteria for evaluation in order to maintain a certain level of care and to ensure that clients get what they need, so we don’t mean to minimize the challenges of changing the standard approach. But we do have strong views about what works best for clients.
The importance of a first session is that it leads to a second session. We can’t help people if they don’t show up. In IFS, we take a nonjudgmental stance and offer compassion from the beginning, recognizing that the client’s willingness to disclose their struggles is hard-won and courageous. As therapists, we aim to embody what we call the 5 P’s: Our patience, perseverance, and perspective are reassuring and calming—while our presence and playfulness are engaging. We notice the client’s parts as they operate in the three categories of manager, firefighter, and exile. We offer a reframe to their struggles by eliciting and validating the positive intentions of polarized protective teams. And, above all, we offer hope: You can feel better, and I can be your guide
In our new book, Internal Family Systems Therapy for Addictions
, we’ve created therapist exercises to help you empathize with the fear and reluctance clients often feel when working through addictive or problematic firefighter behaviors.
Download these FREE exercises
, and truly put yourself into your clients’ shoes to develop and enhance that therapeutic relationship.
This was an excerpt from Internal Family Systems Therapy for Addictions.