expertiseKnowledgeMixed methods therapy

Working with Parts affected by organic bipolar and schizophrenia spectrum disorders

If you are interested in learning more about integrating Internal Family Systems (IFS) in therapy with people affected by bipolar and schizophrenia spectrum disorders, please read on.

My intent here is to share what I’ve learned experientially in working with client internal systems affected by organic bipolar and schizophrenia spectrum disorders using the IFS model. I rely on my past experiences working with these populations as a psychiatric social worker in an outpatient crisis clinic and my current experiences as an IFS-informed psychotherapist.

What do I mean by “organic”?

I believe that in many cases bipolar and schizophrenia spectrum disorders are not originally caused by something outside of the mind. My belief is that many other disorders laid out by the DSM (e.g. major depressive disorder, generalized anxiety disorder) are not biologically innate. They are caused and exacerbated by experiences and energies in the external world permeating into the inner world. I believe they can be best understood as Parts doing their jobs to protect against exile burdens being felt by the system.

However, bipolar and schizophrenia spectrum disorders, to the best of my knowledge at the point of this writing, do not necessarily indicate a burdened exile and cannot be fully alleviated only by the unburdening of exiles.

Differential diagnosis

Bipolar involves marked fluctuations in energy, goal related activities, self esteem, disinhibition, mood, and, for some, perception of reality.

Schizophrenia spectrum disorders involve the individual in a combined presentation of the following: distorted perceptions of reality (e.g. delusions, hallucinations), disorganized and incoherent thoughts, speech, and/or behaviors, and a flattened range of emotive expression and motivation.

I always begin with the assumption that all presented symptoms are a Part until the following occurs, which may take some time:

  • Parts contacted don’t know what to make of the symptoms
  • The symptoms are affecting Parts’ relationship with Self or access to Self energy
  • The symptoms are exacerbating the burden of an exile without a clear good intention from a Part

Important rule outs include:

  • substances
  • medical conditions
  • similar symptoms of other mental conditions
  • Parts related symptoms
  • unattached burdens

Therapist Parts

Parts I’ve found to be especially activated in my own system and Parts that occur to me to likely be activated in other therapists’ systems in cases involving bipolar and schizophrenia include:

  • Parts holding first or second hand experiences with bipolar or schizophrenia
  • Parts that have agendas as to the client’s compliance with treatment recommendations
  • Parts that want to educate the client about the disorder
  • Parts that are enthralled with, critical of, or anxious about the diagnosing process
  • Parts that are afraid the condition is out of your scope
  • Parts that empathize with the client (especially with the client’s exiles)
  • Parts with strong opinions for, or against, medications
  • Parts that see the client as helpless and hopeless
  • Parts that get activated in collaborating with other mental health professionals

Knowing these Parts show up in these sessions helps me to bring attuned Self energy into the room and to make it available to the client’s system.

Therapist Self

The following qualities of Self energy I’ve found to be especially useful:

  • Consent
    • Though not included in the 8 Cs of Self, I’ve come to understand Self as consensual, consistently checking through multiple channels of visible and invisible communication (e.g., words, tone of voice, body language, collective energetic fields) that the interactions are welcomed by the client’s system.
  • Confidence
    • Literally translating to “with faith,” confidence emanates the quality of trust in the field of Self energy to guide the conversation and the relationship between the client’s Parts, your Self, and their Self, to where the light of Self energy needs to flow.
  • Patience
    • To truly understand a client’s system requires time and patience. Some Parts may not be ready at first contact, or even many subsequent contacts, to reveal what it is they protect. For this reason, patience is required in being reasonably confident that a set of symptoms appearing to be an organic bipolar or schizophrenia disorder are not in fact a cluster of Parts.
  • Perspective
    • With consent, sharing the perspective with the client and their system that they have an identifiable, treatable, and organic condition, yet with unknown origins, can help the system orient itself toward Self energy and away from any burdens that are being carried.

Protector perspectives

Client systems affected by bipolar and schizophrenia spectrum disorders have differing positions on the existence of these diagnoses within them.

I recommend first asking for consent to share your hypothesis about what is going on and to educate the client and their Parts with what you know about the diagnosis.

Welcome all Parts that would like to share their responses to the hypothesis and diagnosis. Do Parts agree? Do they disagree? Do Parts have more to share that would confirm or contradict the diagnosis? Did it feel like any Parts felt less (or more!) ashamed upon hearing the hypothetical diagnosis?

Common protectors

Below are the common protectors I’ve seen in working with clients with bipolar and/or schizophrenia disorders:

  • Paranoid Parts
    • These Parts create mild to wild stories that range from unlikely to impossible about what may be happening in the external world and the internal world of others. Their goal can be to make sense of confusing stimuli that are exacerbating a burden and/or to prevent future exacerbation of a burden.
  • Progress Parts
    • These Parts focus on making progress, usually professionally or in mental well-being. They can be especially prevalent when a client needs to take time off work or even leave their job due to having either disorder.
  • Substance-using Parts
    • These Parts are more common with bipolar than with schizophrenia disorders. They are usually firefighters unleashed during manic episodes when energy increases and inhibition decreases.
  • Sexual Parts
    • Again, these Parts are more common with bipolar, and they are usually firefighters unleashed during manic episodes when energy increases and inhibition decreases.
  • Withholding and isolating Parts
    • These Parts take charge when a client has an exile that feels shame about their symptoms.
  • Workaholic Parts
    • These Parts keep busy by working on projects, oftentimes in professional settings. They may ignore the needs of the body and other Parts especially in the midst of manic or hypomanic episodes.
  • Suicidal and self-harming Parts
    • When things feel especially hopeless, these Parts take over and break the glass of the emergency system. These Parts are more prevalent in the depressive episodes of bipolar disorder.

Common burdens

Burdens are rooted in shame, powerlessness, worthlessness, and aloneness. Below are burdens I’ve commonly encountered in cases involving bipolar and schizophrenia disorders:

  • I’m too much
    • This can occur in cases of manic or hypomanic episodes.
  • I’m a failure
    • This is especially true when the symptoms affect the person’s ability to function professionally, socially, and/or personally.
  • There’s something wrong with me
    • I’ve found this burden to originate in or be exacerbated by client encounters with previous treatment providers, especially during involuntary hospitalizations.
  • I’m crazy
    • This burden can enter the system directly or it can be soaked in as a cultural or family legacy burden.
  • Unpredictability and powerlessness
    • Without knowledge about the symptoms of bipolar or schizophrenia spectrum disorders, many of a client’s Parts will be confused, at a loss for predicting when and how symptoms will occur, overwhelmed by the symptoms, and feel powerless to understand or stop them.
  • Burdens subsequent to sexual and other forms of abuse
    • There is heightened risk for abuses of many forms for systems affected by bipolar and schizophrenia disorders. I think mostly about manic episodes where substance using and sex using firefighters, whether they are aware of it or not, put the physical body and psychological Parts at risk for perpetration or actions taken upon the body or Parts from others without the consent of or even the consideration of the client’s system.

Conclusion

I imagine there will be perspectives, possibilities, evidence, and expertise that I have overlooked, or to which I’ve yet to be exposed on this topic. I welcome perspectives on this topic from all readers and their Parts (though a Part of me asks for responses to be as kind, respectful, and Self energetic as possible). Thank you for your time and attention.

Please share your comments below. The full version of this article can be read here.

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1 Comment

  1. Hi Max, Thank you for such an insightful perspective. My own parts, through personal experience and education, don’t believe there’s any such thing as “mental illness” and that mental health is physical and physical health is mental. There’s just one super elegant, interconnected mind-body-spirit. My parts also reject any DSM diagnosis as pathologizing, though appreciate that these can provide some direction for IFS work. My parts also believe that however a person is organized internally is meant to keep them safe in some way. This “wiring” can be extraordinarily complex to untangle, but it is what it is and IFS is one of the best tools and ways through. I also view substances as including all food and environmental toxins, of which there are so many today. As we are biological organisms, our biology is also designed to keep us safe and works in ways similar to our parts to do that. Like our parts, our biology sometimes looks to restore balance and wellness through what appears to be dis-ease. Illness is actually the start of wellness, if we focus on root causes. Our body is always trying to heal itself. So I would also want to understand inflammation and the role of that in these cases and have a doctor of functional medicine or integrative medicine as a partner in the work.

    Not everything can be reversed or undone once it sets in, but taking a holistic perspective on the mind-body-spirit, the role of food and toxins, and also movement would seem to give the best result. I also have parts that know that if there’s a medication that is deemed beneficial, then there’s something out of balance (and the medication furthers that imbalance or masks the cause) and that food, supplements, and movement or removal of toxins could restore that balance. I also know that our parts and our bodies own biological systems and defenses seem to work pretty closely with each other. Meaning parts can create or instruct biology that manifests as pain or illness. As usual, fascinating! Thanks again for your article.

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Author´s Bio

Author

  • Max Littman

    Max is an IFS-informed therapist and consultant in a private practice based in Oakland, CA. www.maxlittman.com

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