Using Internal Family Systems Therapy for Chronic Pain

Pain is the body’s early warning system that something within requires our attention. The default when we experience pain is to inquire about what is physically wrong. Is it a misalignment, a growth, a chemical imbalance, or a reemergence of a previously resolved illness or injury? Exploring an emotional connection is not our first consideration and is often not considered at all. When pain struck me, I did what most of us do—I sought the expertise of a medical doctor.

A Personal Experience with Chronic Pain

My decades-long struggles with chronic pain began with a serious car accident at 19 years old. The accident resulted in lumbar injuries that plagued me for more than 30 years. I received extensive medical treatment involving MRIs, ultrasounds, pain medications, muscle relaxers, and chiropractic and homeopathic interventions. I was desperate to live pain-free. Intermittent pain relief was all that I could achieve. In my mid-20s, while struggling to manage the back pain, I developed debilitating migraine headaches that kept me in bed for days. Everything hurt my head or impacted my vision: Lights were intolerable and sitting upright and standing were impossible. At their worst, the migraine headaches were accompanied by vertigo. Again, I sought medical intervention. Medications worked—until they did not.

In my early 30s, with no resolution of the migraines or back pain, I started experiencing joint pain in my fingers, wrists, elbows, and hips. I was diagnosed with fibromyalgia. At this point in my life, I was experiencing some level of pain on a daily basis. Living in constant pain affected my mental health, and I was diagnosed with depression. The lack of pain-free days made me wonder if my pain had a psychological or emotional component.

Years later, I became aware of a therapeutic modality, Internal Family Systems Therapy (IFS), developed by Richard C. Schwartz, PhD, that helped me reconceptualize pain management by considering the psychological and emotional forces involved. I have found IFS useful with psychotherapy clients who experience pain for which medical interventions were insufficient or that has no medical cause.

How Does IFS Work?

IFS teaches that we are composed of subpersonalities or “parts” that either protect us from emotional and traumatic pain or hold traumatic memories and experiences. The parts that protect (referred to as protectors) are shielding us from the parts that hold the trauma (referred to as exiles). Trauma wounds—or burdens, as they are called in IFS— cause exile parts to feel ashamed, unworthy, unlovable, alone, or not good enough.

The role of our protectors is to keep exiles hidden to protect us from feeling their pain. Protectors accomplish this in two ways. There are protectors who act in preemptive ways to keep us from experiencing the burdens of our exiles and to keep these parts from further hurt. These are called managers, and they attempt to control the external environment, people, and situations. The second type of protectors respond reactively and are called firefighters. They spring into action when feelings of shame, unworthiness, or aloneness of exiled parts are triggered. The firefighter must extinguish the emotional “fire” and uses tactics of dissociation, numbing, or self-harm to do so. Exiles desire to be seen, heard, and valued. This impels them to share their story in hopes of redemption and validation.

The Healing Capacity of Self

In addition to our parts, IFS teaches that everyone has a wise, intuitive self. The self is who we are when our parts are not activated. The qualities of self are compassion, curiosity, calm, connectedness, clarity, courage, creativity, and confidence. Self comes into relationship with our parts through these qualities as an inner resource for healing. Self does not force healing. It is an offering that parts can accept or deny. However, when parts are listened to with compassion and curiosity, they are more open to the healing offered by self.

Our parts, managers, firefighters, and exiles use pain to communicate with us—and to get our attention. In my own life, when years of medical interventions were ineffective and new pain syndromes developed, I had to look deeper. I started to notice an increase in physical pain when I was overwhelmed, stressed, avoiding unpleasant feelings, or denying reality.

IFS helped me understand the healing capacity of self and showed me how to foster a relationship with my part that used pain to communicate with me. To develop a relationship with our parts or “befriend” them, we ask them to “unblend” or separate from us. When I noticed the pain of a migraine headache, I would ask the part to give me space by reducing the intensity of the pain. Touch is a powerful tool that I often use to connect with my own system, so I would use touch to let the part know that I was present and available to hear its concerns. I would place my hands on the part of my body in pain and ask the part a question: What do you want me to know? What brought you forward today? What am I not getting?

The part shared that I was overcommitted and didn’t take time to rest. I worked to exhaustion, handling responsibilities to my family, business, and friends while ignoring the needs of my body for rest and downtime. I learned that the part felt it had no other choice but to stop me by causing debilitating migraine headaches. As my relationship with this protector deepened, it shared that it protected an exiled part who did not feel good enough. I came to understand the coalition of parts connected with my migraine headaches. I had a part that pushed me to take on responsibilities to the point of exhaustion to prove my worthiness (manager), while another part used migraine headaches to make me rest or detract from feelings of unworthiness (firefighter). Both parts protected the exiled part who felt not good enough. When I addressed my childhood trauma related to feelings of unworthiness, I achieved full remission of the migraine headaches and the need to push myself to physical exhaustion to prove worthiness.

Pain is a communicator. It may have a physical, emotional, or psychological cause, or some degree of each. If a physical cause has been ruled out by a medical doctor, your pain is greater in severity than the diagnosis, or you want to explore the possibility of an emotional or psychological connection, IFS is a tool that can help you listen to your pain parts and bring healing to your body and mind.

Practice: Listening When Pain Parts Speak

Directions: Try this practice when pain is at a 5 or less on a 1-10 scale.

1. Notice how you experience the pain; identify its location, intensity, and sensations.

2. Bring your awareness to this experience by focusing on it.

3. Notice any thoughts, mental images, or emotions accompanying the pain.

4. If the thoughts, images, or emotions could speak, what would they say?

5. Ask the pain what it wants you to know about it. Listen with compassion and curiosity. Ask questions of the pain for clarity.

6. Journal what you discover.