An examination of internal family systems interventions for trauma with implications for ethical psychedelic-assisted treatment

Internal Family Systems (IFS) therapy, which views the mind as composed of multiple subpersonalities or 'parts' shaped by trauma, has gained popularity, particularly in psychedelic-assisted treatments. However, outcome data for applying IFS to post-traumatic stress disorder are limited, and its theoretical assumptions are difficult to test. The model's appeal highlights a problem with how empirically supported treatments are perceived. Ethical recommendations for presenting IFS include providing detailed psychoeducation about evidence-based treatments, being candid about the experimental nature of alternatives, monitoring progress, and watching for harm. Drawing on IFS's appealing features to improve perceptions of validated treatments may attract more clients and reduce dropout while awaiting empirical evidence.

Study at a glance

Abstract

Though several treatments effectively address the pervasive impact of trauma, they do not achieve complete symptom resolution for all clients, inspiring the search for alternatives. Internal Family Systems (IFS) therapy has grown popular, especially in informal psychedelic-assisted treatments (PAT). Compared to stereotypes of empirically validated, exposure-based treatments, IFS has novel facets with widespread appeal. The model encourages improved quality of interactions among multiple, naturally arising “parts” or subpersonalities potentially generated by traumatic experience. The body of IFS literature is extensive, enthusiastic, and thought-provoking. Outcome data for applying the model to Post-Traumatic Stress Disorder are limited. Attempts to operationalize and falsify the theory's assumptions and proposed mechanisms will likely prove challenging. Nevertheless, the model's popularity underscores a problem with perceptions of the empirically-supported treatments. Contemplating ethical ways to present the IFS approach given the state of relevant research, we note strategies that would apply to recommendations for PAT of any type. These strategies include detailed psychoeducation about empirically-supported treatments, candid description of the experimental nature of alternatives, frequent assessments of improvement, and detailed monitoring of potential iatrogenic effects. Drawing on facets of IFS to improve perceptions of the empirically validated treatments might provide an efficient way to appeal to more clients, decrease drop out, and increase gains as we await results of empirical investigations of IFS-influenced PAT. These steps can allow clients to choose an approach consistent with their own impressions of a credible intervention, potentially leading to better outcomes.