Swim session 1: Peer Practice and Consult (PPC) Groups

SWIM SESSION ONE: Peer Practice and Consult (PPC) Groups

A Place to Cultivate Connection with Self-energy

In this article, Mona Kim, RSW, and Denise Bike, PhD, discuss the role of ongoing peer support in the clinical practice of Internal Family Systems (IFS). They share their ideas about developing a peer group that alternates meetings between practice and consultation. This Peer Practice & Consult (PPC) group model is designed to deepen members’ awareness of Parts’ contributions and of the presence of Self-energy. Given the experiential nature of the IFS approach, Mona, Denise, and the other group members have found their twice-monthly PPC group to be a natural extension of the learning process beyond formal IFS training. They invite anyone reading this who is interested to connect with them, to get in touch. You can connect with Denise and Mona via email: PPCGrps@gmail.com

How the PPC Group Began

Mona began the group in Fall 2019, as she progressed through the IFS Learning Circle Program and found herself seeking “connection, community, belonging,” and a place to practice with other regulated mental health professionals. She was intentional about recruiting members matched in their level of professionalism and positive regard for those we serve. All members completed the IFS Learning Circle and three of the current five have been Level 1 trained. We are also all EMDR trained and specialize in treating trauma.

Our members’ shared qualities created quick cohesion through common training experiences, language, vocation, and commitment to the IFS model in our daily lives and practice. Clinical peer groups cohered in this way, can more quickly reap such benefits as increased self-awareness and clinical ability, improved self-care, reduced likelihood of burnout, and decreased isolation (Miu, Joseph, Hakim, Cox, & Greenwald, 2022).

Members are unique in other ways, bringing a balance of heterogeneity to our PPC group. We differ in where we live (we are a Canadian and American mixed group), the populations we serve, our areas of expertise, as well as culture, gender, sexual orientation, and neurodiversity. Our differences provide variety in our perspectives on and applications of IFS.

Benefits of Peer Practice

Every other meeting, we practice our IFS skills. We experiment, make mistakes, and pause the work to check in with our Parts and to ask each other questions about what we’re experiencing. As in formal IFS trainings, we begin with a meditation to connect with our Parts, creating space to contact Self-energy. We then practice using ideas members suggest from trainings, readings, and other materials. For example, activities have focused on deepening Self-awareness during the 6 F’s, investigating somatically, trying new language to enhance Self-to-part connections, and exploring psychodrama techniques to unblend and connect with Parts. We also debrief at the end of each practice activity.

Having built trust with one another over time, we’ve continued to evolve the format of practice time. Most recently, we’ve inserted space for therapist-role and observer-role Parts to be voiced throughout the practice, by using a timer set for every five minutes (rather than waiting for the debrief at the end). This change has increased our ability to access more Self-energy during practice, breaking old habits of ‘pushing through a technique’ while blended.

Pausing to connect with Parts during practice also helps us benefit from the wisdom of our Parts, as Self makes choices of how to bring a part’s skillset or insight to bear in the activity. As Rønnestad and colleagues (2019) observed, “continuous professional reflection … optimally leads to counsellors and therapists being reflective practitioners throughout their professional lives” (p. 226). Our check-in approach used during practice time has significantly increased awareness of Self-energy by making room for our Parts.

This approach to practice fosters a sense of belonging—between and within our Selves—which builds confidence in our use of IFS and keeps us present. Trying new approaches within a safe peer context also feeds a desire for novelty, safety, and learning. As Mona notes, “our continuous practice and consulting reinforces that every experience is individual and unique.” We value the experiential nature of our practice time, which has helped us become comfortable in the discomfort of the unknown that we often face as clinicians and in our personal lives.

Benefits of Peer Consultation

Alternate meetings are used for case consult, to discuss our clinical work. In addition to offering answers to fact-based questions related to the content of a case, we reflect, problem solve, validate, and challenge throughout our process. We respectfully share de-identified client information (abiding by ethical and legal considerations about confidentiality) and engage in inquiry around questions like: I think this is the trailhead, but what have I missed?; Does my conceptualization of this polarization seem accurate?; and, What approaches might help this client become more aware of Self-energy? We explore responses through everyone’s unique seats of experience, understanding, and knowledge. There is also assurance that we don’t have to be perfect clinicians (because we are not) doing perfect work (because we cannot).

In a recent change to our consultation approach, we’ve begun pausing during consultations at timed intervals to be with and speak for our Parts, deepening the Self-to-part connection during consultation. A focus on both content and process is now prioritized throughout the meeting, as endorsed in recent literature (e.g., Miu et al., 2022; Napan, 2021). We do this in two ways:

1) The person presenting a case checks in with their Parts after they present, connecting with Parts that are activated. This unblending increases understanding of what activates them in session—with this one client and likely across clients. This unblending also invites more Self-awareness into our consult.

2) The members offering consult also touch in with their Parts activated by the client being discussed. This unblends therapist Parts as well as Parts activated by the case content, deepening the relationship with Self and Parts.

Denise finds that “this approach shifts the consulting process from the cognitive to the visceral, moving us more deeply into our hearts and bodies.” As the consult meeting progresses, we repeatedly check in to observe and give voice to Parts arising.

Remaining aware of Parts throughout consultation appears to have multiple benefits during consult time. The vulnerable position of the presenting member is treated with more care, resulting in reparative experiences with younger Parts put on the spot, for example, during earlier schooling and or perhaps during later clinical training experiences. Each member also appears to operate with more access to Self-energy, so the habitual free-for-all of throwing suggestions at the consulting member is greatly reduced. Confusion about how to proceed with a given client caused by interference from the clinician’s Parts (often resulting in the same case being presented multiple times), has been reduced. Recently, we’ve discovered that there also appears to be a group Self-energy that resonates with the client being presented and may increase attunement to the client’s system (Altfield, 1999).

Benefits of Using the PPC Group Model

The nature of combined practice and consultation—with intentional time spent reconnecting with Self-energy—increases reflection, growth, and development. “Inherent to [the IFS] model is the assumption that therapists need to understand and manage their own internal system before they can be effective in helping clients to gain an understanding of their own” (Mojta, Falconier, & Huebner, 2014, p. 69). Beyond formal training, a PPC group offers space to accomplish just that.

Mona has noticed in her work with clients that, since starting the PPC group, “there is a different quality to therapy sessions—I notice an ease of flow towards well-being for clients. I think this is from creating space to be aware of Self-energy, within my Self and also within clients.” In her clinical work, Denise has found a similar benefit. “It’s as though the rhythm of checking in with my system during PPC group has been internalized. Opening repeatedly to Self-energy in timed pauses during consultation and practice—with colleagues who are doing the same—has exponentially deepened my ability to do so with patients in session.”

Our Group Members’ Experiences

The effectiveness of the PPC group model—in particular, taking time to re-connect with Self-energy throughout the meeting time—is also palpable to the other members (Paul, Brandy, and Susan). As Paul observed, “My faith in the healing process [using] IFS is deepened by our shared experiences, exercises, and consultations. We get to go beyond texts and online video and talk about what really works or might work in the room [with clients].” Indeed, the research shows that peer group participation coincides with one’s ability to self-reflect, to behave ethically, and to improve awareness of one’s behaviors in session (e.g., Knapp, Gottlieb, & Handelsman, 2017; Venkatesh & Lovibond, 2019)—key components of accessing Self-energy in clinical practice and in life.

Much like when serving clients from Self, a Self-aware PPC group feels like a give and take of energy that fuels us all. Brandy has found that “the structure of consultation and practice is a balance that lets me grow. My therapist Parts love talking about IFS; but the growth of Self-awareness in practice has been invaluable. … I have been able to observe other’s Self-awareness and speaking for Parts that gives my system a model of ways to have those relationships.”

Susan has also been touched by the unique processes taking place in our PPC group: “It has been helpful to know that other therapists often share similar concerns and experiences and have similar Parts. You feel less alone on your learning journey which is comforting and empowering at the same time….I would highly recommend that all therapists connect with a group.”

Author’s Bios:

Mona Kim, RSW, speaks from the perspective of an Asian Canadian, born to Korean immigrants, who is a cisgendered female, parent, neurodiverse, and identifies as queer and lives within a mixed orientation relationship. As a therapist, Mona has decades of experience working with children, teens, and adults in hospital and outpatient settings, including more than a decade support for victims of sexual assault, intimate partner violence, and sex trafficking. She came to IFS in 2018 and was drawn in particular to IFS’s experiential forms of training. Mona started this PPC group during her participation in the IFS Learning Circle.

Denise Bike, PhD, identifies as a White, raised working class, cis-het US psychologist specializing in adult ADHD, anxiety, and early trauma. She learned IFS using an in vivo consult model in 2010 while interning at an intensive outpatient program at Boone County Hospital. She has completed the Learning Circle and Level 1 trainings in IFS. She joined this PPC group in Fall 2020. Her work has been published by the Journal of Black Psychology, Journal of Clinical Psychology, SAGE Publications, and the American Psychological Association.

References

Altfeld, D. A. (1999). An experiential group model for psychotherapy supervision. International Journal of Group Psychotherapy, 49, 237-254.

Knapp, S., Gottlieb, M. C., & Handelsman, M. M. (2017). Enhancing professionalism through self-reflection. Professional Psychology: Research and Practice, 48, 167–174.

Miu, A. S., Joseph, A., Hakim, E., Cox, E. D., & Greenwald, E. (2022). Peer consultation: An enriching necessity rather than a luxury for psychologists during and beyond the pandemic. Journal of Health Service Psychology, 48, 13-19.

Mojta, C., Falconier, M. K., & Huebner, A. H. (2014). Fostering self-awareness in novice therapists using Internal Family Systems therapy. The American Journal of Family Therapy, 42, 67-78.

Napan, K. (2021). The spirit of peer supervision. In K. O’Donoghue & L. Engelbrecht (Eds.), The Routledge international handbook of social work supervision. Routledge.

Rønnestad, M. H., Orlinsky, D. E., Schröder, T. A, Skovholt, T. M., & Willutzki, U. (2019). The professional development of counsellors and psychotherapists: Implications of empirical studies for supervision, training and practice. Counselling and Psychotherapy Research, 19, 214-230.

Venkatesh, S., & Lovibond, P. (2019). Is the unexamined professional life worth practicing? Factors influencing ethical practice with psychologists. Ethics & Behavior, 30, 326-341.