Internal Family Systems and working in healthcare – with Wendy Kendall

by | Nov 21, 2022 | Podcast

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Internal Family Systems, or IFS, is a relatively new model of psychotherapy with a growing evidence base.

In this episode Dr Paula Redmond takes a closer look at IFS with occupational psychologist Wendy Kendall. Wendy explores its application for making sense of how we relate to work as healthcare professionals, and how IFS can help us find space among the overwhelm.

Wendy is a chartered occupational psychologist and an IFS practitioner who specialises in helping self-employed psychologists grow their private practices.

You can find out more about Wendy’s work on her website, and connect with her on LinkedIn.


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Transcript

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Dr. Paula Redmond: Hi, I’m Dr. Paula Redmond, a clinical psychologist, and you are listening to the When Work Hurts podcast. On this show, I want to explore the stories behind the statistics of the mental health crisis facing healthcare professionals today, and to provide hope for a way out through compassion, connection, and creativity. Join me as I talk to inspiring clinicians and thought leaders in healthcare about their unique insights, and learn how we can support ourselves and each other when work hurts.

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The Internal Family Systems model or IFS is a relatively new model of psychotherapy with a growing evidence base. I wanted to learn more about what this model could teach us about the ways in which we relate to work. To do this, I spoke with Wendy Kendall, a chartered occupational psychologist and IFS practitioner who specializes in helping self-employed psychologists grow their private practices.

She started her 25-year career as a psychologist for the British Army before moving overseas and running her own talent development consultancy. Among other things, she is co-founder of The Self-Led practice, the healthy virtual workplace for mental health professionals. We kicked off by discussing why Wendy was drawn to the IFS model.

Wendy Kendall: As an occupational psychologist, my focus is really on the psychology of people in the workplace, and I ended up coming across the internal family systems model through a podcast. It was really kind of random. It was nothing to do with my professional context at the time. Hearing about it, and I’ll kind of explain some of the particular features of the IFS model, but when I heard the description of how IFS helps us understand and relate to our internal experiences, it made so many things make sense in so many different contexts.

Even though I’m not a therapist, I decided just to go and get trained in it. The interesting thing is it is a framework of understanding our inner experience that is very accessible and applicable in lots of different contexts. That kind of utility I found very appealing. As I said, IFS stands for the Internal Family Systems model.

There’s both therapeutic and coaching and all kinds of applications to it, but the particular perspective that IFS brings is rather than considering, we consider that the mind is naturally and normally multiple. In other words, we have lots of different parts of ourselves in our mind that we relate to. They might be our internal voices, they might be some of our nonverbal internal experiences, they may be different beliefs that we hold, and so on.

There has been a tendency in psychology to consider the mind and our experience as a unitary whole, it’s just us thinking things or experiencing things like emotions. We’ve also tended to pathologize this multiplicity, this experience of the different characters that turn up in our minds. For example, if you start to talk about listening to the voices in the mind, then a natural or normal kind of question is, are we talking about something like DID, dissociative identity disorder?

This multiplicity has been put in the category of something that is kind of disordered overall and we’ve moved away from acknowledging that is just the way that actually we experience our consciousness. The other element of IFS that’s really important is that, yes, we have this experience of multiple voices, different parts of our personality showing up, but that the internal family aspect is that those multiple parts of ourselves relate to one another in different ways.

For example, we might have a really strong inner critic that comes in to criticize us after we’ve done something and then we may have another part of ourself that comes in and says, “No, don’t worry about that, it’s okay,” and rationalizes it. Those parts of ourselves have a relationship between one another. That is the system, the family system, element of IFS.

Paula: Can I ask Wendy why it’s called family system?

Wendy: I think it’s a good question. I’ve not heard– the originator of it is a guy called Dr. Richard Schwartz, and I’ve not heard anyone ask him why it’s a family. However, one of the reasons I think is he comes from a family therapy background. The story that he tells about the discovery or the uncovery of IFS is he was trying to apply regular family systems therapy to his clients and it wasn’t working.

Then he got curious about the inner experiences that they were sharing with him and it reminded him of the principles of family therapy, which was working on changing the roles that people had in the external family. He started to explore whether those principles could apply internally. I think it also, for me, anyway, when I think about why a family, all of these parts are kind of parts of us as an individual. They come from the younger experiences that we had. They come from the professional and personal experiences we’ve had. They’re all parts of us and therefore it’s our internal family in that sense.

Paula: That makes a lot of sense if thinking about, I suppose, therapy work where sometimes it’s about reparenting ourselves, whether that’s because of early experience or because we’re feeling wounded and vulnerable like a child or that inner child and something about resourcing ourselves to parent and care for ourselves in a way.

Wendy: Exactly. That’s a similar process that IFS would use as well. There are overlaps with different forms, not a unique therapy in that sense because there are other forms of therapy that do that kind of parts work. I think the one thing that’s really key with IFS that is perhaps slightly different is there’s this central idea of a resource that we all have, which is something called self or Self-energy. It’s usually, in IFS, referred to with a capital S.

The argument is, or the principle, is that all of us, no matter what, have available to us this self-energy resource and it’s the wounding experiences that we have that break down our inner trust in our ability to access that. IFS is about helping people to rebuild trust with their ability to connect with self-energy. Self-energy has eight Cs, eight qualities beginning with the letter C. They are courage, curiosity, connection, calm, confidence, creativity, compassion, and clarity.

When we are working with someone using IFS, often what we’re checking is how much access do they have to self-energy at that point. What signs of that can we see and how can we help them build a connection between that place of self-energy and the parts of them that need the repairing, the reparenting, and so on?

Paula: I think that’s a really helpful, important idea about needing to rebuild trust in our own ability. I really see that in working with health professionals who are struggling with burnout, for example, or have been really wounded by experiences at work, whether that’s bullying or being exposed to traumatic stuff, and just that sense of becoming really disconnected from all of those Cs and losing their sense of self and that being really painful.

Wendy: Exactly. Having experienced burnout myself early on in my career, I know that one of the hardest things to get back, and which, actually, years later, IFS, for myself, was really useful for, was reestablishing self-trust because the core experience was one of such complete failure. Having been someone who just maybe came out of University feeling incredibly competent and confident and then experiencing what felt to me like a complete failure and being off for a few months with burnout, the internal rupture of trust is enormous. No matter what the external validation after that, there’s some internal repair work that still needs to happen. For me anyway, going through the learning process of training in IFS and then having my own therapy and my own coaching in that as well was also fundamental to really flourishing after burnout and not just coming back to zero.

Paula: Maybe we can think then about how IFS can help us in a non-therapy context. I know you do a lot of work with mental health professionals and other psychologists. How could we apply these ideas to those contexts?

Wendy: The way that I typically conceptualize IFS with my clients rather than just talking about IFS, because it’s not always such an easy conversation to have right up front at the start of a coaching conversation. How to help people get their head around it without going into the technical details, I talk about working with your inner leadership team. Can we be the CEO of ourselves, and the CEO that we would like to have in real life?

In other words, the person that embodies those 8Cs that offers curiosity to the inner team members when they show up, the person who is helping them to feel more confident, who helps them to experience compassion when things have gone wrong. Putting ourselves almost at the head of the board table and recognizing that those experiences we have, whether it’s inner critic, whether it’s imposter, whether it’s a part that comes in and wants us to numb because we’ve had an overwhelming day, whatever it is, those are team members who are all here to help us, who are all there to help us function and to survive and to get through the day.

That’s one thing, one concept to work with. We’re going to be helping ourselves and working with those parts of ourselves just like we would want a really great manager or leader to work with us.

The next thing is thinking about, can we build into our day and our week experiences where we can connect with self-energy. Can we do that on a regular basis? Because when we are so overwhelmed– You and I have discussed this concept, I know, previously, about the drive system and about being overwhelmed and just doing more and working harder and so on.

Even while we are blended with a part of ourselves that is very driven, is it possible for us to go for a short walk and see if we can connect with something like a sense of calmness or a sense of connection, and bring a little bit of self-energy also to that very driven part of ourselves.

That would be another example. In fact, when I’m coaching people, especially when they’re highly stressed, very driven people verging on burnout, and so on, that’s one of the principles. Where were we building in opportunities to connect with self-energy and what are the places we can do that?

I think another key idea is to remember that the parts of us that are experiencing the burnout, the parts of us that are distressed, that are having difficulties, those parts are not their burdens. They’re parts of us usually that have had experiences that have caused them to function in extreme ways. Whether it’s extreme hard work, whether it’s numbing through self-medication, or whatever it is. Those parts are not their burdens.

It’s our role as a self-led individual to help those members of our inner leadership team with their burdens, not to exile them and get rid of them. We are not trying to get rid of your hard-working part, we’re trying to understand what is it that’s driving the extreme amount of hard work, and see if there’s a way that we can help them to offload that burden.

Paula: It’s quite a profound idea that all parts are welcome, isn’t it? Quite a countercultural one because I think-

Wendy: I agree.

Paula: -that there’s a lot of push or emphasis on honing ourselves and being the best we can be, whether that’s physically, mentally. This idea that actually all parts are welcome is something really to get your head around.

Wendy: Definitely. That’s a really fundamental and important principle in IFS. I’ll just explain a little bit about why that is. First of all, we can’t ever, actually, get rid of parts of ourselves. We know about brain plasticity. Even if you were to locate an area where there was a part, which I don’t even know that you could, and then you removed it, that part still exists in other parts of your brain. We’d literally just can’t get rid of parts.

One of the most wounding experiences that we have is that of being exiled in our families. When we do that internally and we shame, ostracize, and retraumatize parts of ourselves by shoving them to the outer edges of our psyche, we’re experiencing something traumatic again. This idea that, for example, with inner critics, exile it, drown it out, don’t let it have any air time, especially when we are stressed, that is adding to the trauma burden rather than saying let’s understand what’s happened in the past that has caused us when this part is taking over our experience, can we understand why it’s doing that?

Let’s apply a listening ear. It’s really hard, even with our own external family members, to experience that kind of exiling. When we do that internally, it’s a very difficult experience to deal with. On the other hand, if we can welcome those parts in, actually we start to unburden the system. That allows all of these younger parts of ourselves, these resources, this sense of playfulness we may have had when we were younger, the joy and the rebellion of being a teenager, all of these wonderful resources that we have available can come back into the system and be available for us now.

Paula: How can we do that? How can we welcome and open up to parts we might not like?

Wendy: Exactly. The first step typically is to see if you can be curious. When we have those experiences where maybe we’ve done something and we felt as though it didn’t go as well as we wanted and we have that inner critic– Inner critics really show up a lot in our culture. Is it possible to get curious about and ask that part what it’s trying to protect us from? What role is it playing? When did it get that job?

Often when we ask those questions, there’s some internal wisdom that comes up. We know. The experience is there in the system. We may not have paid attention to it for a long time. We know where that voice came from and we know when it first started. From that, sometimes, we can find some compassion for ourselves. Typically, and that’s an example of how we start to connect with that self-energy, curiosity, compassion, connection, clarity.

Paula: In your experience of working with mental health professionals, what parts of this process do we find most tricky?

Wendy: When you say this process, which bit do you mean?

Paula: I guess opening up to the parts. I was going to say which parts do we find most tricky?

Wendy: I think this unblending from being very driven is something that we need to build a habit around. So many of us have been very successful by being very driven and being very focused and very typical. When we start talking about whether it’s possible for that very driven part to soften and to relax a little bit, how would it be to not work so hard, the response that comes back is, “Well, if I don’t do this, I won’t be me anymore.” When you really listen to what that part is saying, that part’s perceiving it as an existential threat, “If I don’t do this so much, so hard, as driven as this, I won’t exist anymore. I can’t envisage a different way.” It’s a question of building confidence and connection with that part and really validating how much good it’s also done in our lives to get us to this point. Really welcoming that part, which might seem counterintuitive but again  what we’re trying to not do is to shame it, exile it, which just creates much more distress in the system.

Paula: As you’re talking, I guess, my brain is flipping between thinking about all of these parts within individuals and thinking about individuals within a team, and all of this stuff coming up and then the complexity of everyone in a team having all of these parts and what parts show up in our colleagues at work.

Wendy: Exactly, so that happens quite quickly. I think what can start to happen is you start paying attention to what are the parts of you that turn up. First of all, first stage is mapping, even just paying attention on a journal and just thinking about what are the usual voices or the experiences that turn up?

Sometimes, for example, it may be inner critic, it may be that very driven part, and then we might also have a part that comes out in sympathy by giving us a bad neck when we’re stressed, so just making a little map of that in a journal is useful. Then we start to notice those similar parts that turn up for our colleagues, and that’s interesting as well, just to notice that. A useful technique then is sometimes to start speaking for parts, not from parts.

For example, how would it be to say, rather than, “I’m really stressed and I can’t believe that you’ve made this mistake again,” say, “A part of me is feeling a lot of stress and can’t believe that that mistake has happened again.” Because probably not all of you that’s really stressed and can’t believe this happened. In another situation, feeling less stressed, the more compassionate and the more the part with a lot more perspective might be able to come in.

Just that technique of speaking for a part rather than from a part is a good way of unblending and unhooking from it in the moment. Sometimes that invites people to also do the same. Now, obviously, use a bit of judgment as to how that might land, but this speaking of parts is actually normal in our language anyway. A part of me thinks this and a part of me thinks something else.

It’s not uncommon for us to refer to our experiences like that, but I’ve done them, I’ve run team workshops, so using strength profilers, for example, can really see strengths represented in some of the psychometrics that we use as occupational psychologists, and just getting people talking about when they’re operating from a strength, which is often a very competent part, and how would it be to open up space for some of their other strengths, and how would it be when you are working within that strength. How about your colleagues? What strengths are they turning up with? Is that complementary?

It’s easy to slip into thinking about the different ways in which we show up in different contexts.

Paula: Just my sense in listening to you is it helps things to feel less stuck, that there’s more possibility and more room for movement and flexibility.

Wendy: Exactly that. The experience of unblending, for a start, which is this, “Oh, I recognize actually that I was really operating from this one part of myself” is in itself creating a space for a response rather than a reaction.

Paula: Just thinking about some of the contexts of the people that I work with, which is in the NHS, very pressured environments, relentless demands, and the systems within the systems, what might be going on with individuals and teams they work closely with. Then all the stuff that’s coming from outside. How do you think that we can draw on the IFS wisdom to make sense of everything that goes on, or maybe not make sense of everything that goes on, but to create some of that space, some of that room for movement when there’s so much overwhelm?

Wendy: On the one hand, it’s often the case, the conversation that I have with mental health practitioners is we can’t change everything by changing nothing. We have to find the areas that can change, but change it is. If you always do what you’ve always done, you’ll always get what you’ve always got. [chuckles]

Individually let’s start with what’s within our control as individuals and just think about how are we bringing those sources of self-energy into resources? When can that happen? Is it about something that can happen on the commute in some way? Will it require some kind of boundary being put in there or some kind of decision?

I would think about where can you bring in those sources of self-energy? Is it in moments of connection where maybe you have that opportunity with colleagues or with clients or with patients and just savor a moment of connection? That sense of being able to savor some of those experiences of self; creativity, calm connection, courage and so on, can also build that sense of resource in the system.

Recognizing, I think, that for you and also for the colleagues around you in certain environments, what you are seeing is not all of them. Remembering that you’re seeing the highly activated manager and protector and firefighter parts, but that that is not all of them. I just remember that sometimes allows a little bit of that space in to remember that that might be them in the moment, but it’s not all of them.

In terms of the interpersonal application of IFS or recognizing when you’re feeling overwhelmed that this is, perhaps, you being very blended with a very driven and energized part of yourself and seeing if it’s possible to go inside and to find that curiosity about what’s going on for you. Asking that internal inquiry, that gentle inner inquiry, and if it’s possible to send some compassion to that part of yourself at that time.

Then coming back later with the other person and seeing if it’s possible to speak for the part of you that was activated and to repair the relationship if something has happened that ruptured that relationship. Also, recognizing that it’s not possible to be perfect all the time, and what we don’t want to do is also be really hypervigilant around that and just increase the overwhelm.

Then I think the other thing that can be really useful is to spot those signs of strength in action in other people. Parts of us are not just these parts that are perhaps burdened through overwhelm and overwork, but also the gifts that you’re bringing in, that you’re using, the resources that you’re bringing in and using, the strengths that you’re applying and using, and seeing if you can start to spot that, not just for yourself, but also for your colleagues, recognizing their gifts, their resources, their strengths, and reflecting on that with them.

That in itself can start to build opportunities for more self-energy, more connection, more clarity, more calmness, more confidence, more creativity.

Paula: I’m just thinking that, in the NHS, which is such a complex system, and I’ve not come across an organizational psychologist or occupational psychologist working into that, which seems crazy, and I just wondered if you have any reflections from an organizational psychology perspective, if you had a magic wand or– what changes could happen in a system like that to support it.

Wendy: Creating awareness of that inner system I think is really important. It reminds me, there’s some work, I’ve not got the reference here, but there was some work by a Nobel Prize-winning chemist about the nature of systems and how we can create tipping points through individual action on larger systems.

What happens is that, through the glomeration, through the action of many different parts of a system, the parts that resonate with one another end up coming together and then creating bigger and bigger connections, larger networks of connections across those systems. There is hope for us. There is hope for these large complex systems that actually creating changes at the individual level, for me that would be creating knowledge or helping people to understand their inner system systems to understand how. Really, what we are doing there is  creating a high level of self-awareness of what’s happening for us. Creating opportunities to experience more self-energy can start to lead to bigger system changes as we shift the way in which we work with one another.

Is it a panacea for everything? Probably not. We’ve got all these external dynamics that come in that none of us have control over. There is hope for us that by creating change at an individual level, creating change with the people around us, that that can start to have a larger knock-on effect.

Paula: I’m curious about the work that you do and how that manifests some of this stuff. Could you say a bit about that?

Wendy: One of the areas I work with a lot. When people come into their private practice or people are expanding the work that they’re doing in their private practice, they are often coming into private practice with those parts of themselves that have learned certain ways of working.

Paula: Is that from having grown up in the NHS?

Wendy: Yes, some of it is. Some of it is also what you had to do in order to get qualified to then go and work in the NHS. 7 years of study and training and so on, and then you’ve spent maybe 15 years in the NHS as well. I was originally working in Ministry of Defense, so it was UK public sector that I started out in as well and got burned out in. [laughs] It was a similar context, but often what’s happened is that we’ve learned ways of being in work, and we bring that same way of being into our private practice.

That hyper-focus can be really effective, but when it stops working for us, suddenly we don’t know where to go with that. People say to me things like, “I realize I’ve been a bit institutionalized. I’ve just got one way of working. I’ve got all these creative ideas, but I don’t believe in my ability to deliver on them.” That’s a process of helping people to discover and connect with those probably much younger parts of themselves that were much more creative and hopeful and aspirational and idealistic and all of those other things.

Internally giving ourself permission, giving those hard-working, somewhat inflexible, maybe burnt-out parts of ourselves, permission to not have to work so hard, to dial it down a bit and to give space to creativity, different ways of working, different purpose, different passion. Then what happens is a kind of emerging and a new sense of self because suddenly we realize we are not just that one thing, we are all these other things as well.

Paula: Yes, and I can certainly resonate with that in terms of sometimes we might make decisions to, for example, leave the NHS or to do private work alongside, in order to achieve something different, in order to create more space for us or to explore other avenues, and it’s very easy to be caught up in the same stuff that we thought we left behind.

Wendy: Yes, and it’s normal because the people that we end up connecting with who want to work with us are like, “Well, all this stuff that you’ve already done, can you come and do it for me as part of your private practice?” You’re like, “Well, yes, because I can do it and I feel like I should accept the work.” We get on that treadmill of carrying on doing the things we’ve always done.

Paula: Given all your psychological wisdom and your personal experiences with burnout, if you don’t mind saying, what are the things that keep you going now? What do you have in place? What are the habits that support you?

Wendy: I love these questions because I’m literally writing an article about it today.

[laughter]

The article that I’ve been working on this last week or so. I was awful for not going to bed early enough. I would get into a place where I was so driven that my brain literally couldn’t switch off at night. If I have a computer screen on past ten o’clock in the evening, I am not sleeping until 3:00 AM. Therefore, I am not having a computer screen on. I don’t work late evenings. I have to sleep. Weekends, I’m a devil for taking on too much and shoving it into the weekend. I can’t do that anymore. If I do that, especially over a series of weekends, I will burn out, so I can’t do that.

Then the other thing is I typically don’t organize my meetings now before 10:00 AM because I get up, I connect with my husband, and I take my dogs for a big long walk, and therefore I get my exercise in as well. Those are my three pillars, which just may seem really obvious, but for so many years, I neglected them.

Paula: I think it often does come down to some of those just fundamentals, doesn’t it? It’s so easy for things to creep, especially that’s the downside of technology, isn’t it? That I often have conversations with people about not having work emails on your personal phone, and you have to bring a work laptop home, put it in a cupboard, just out of sight to some of those ways of really protecting those parts that need to switch off.

Wendy: Yes, the experience of those managers and protectors that want to keep us safe is usually that they’re overwhelmed and exhausted. All of those parts of us that get the burnout are the parts that are trying to keep us safe by making us work really hard and hold everything together. Often, when we ask them, “How would it be to not have to work so hard?” They’d say, “That would be awesome, but we just don’t know how we can do that and still exist and keep you safe.”

Paula: I like that idea of just the way you put it there, the parts of us that are burnt out, which suggest that there are other parts that are still okay, and we just need to find them and access them.

Wendy: They are, and there’s a little secret in IFS as well. It’s an experience I’ve seen talked about in the various IFS groups. I’ve not seen anyone writing about it yet, so much. When we take that time to listen and do the unburdening with some of our parts and really apply that compassion with those parts of us that are really overwhelmed and burnt out, and we start to get some of that sense of space, as you described, that sense that actually we’ve got a few more choices here, and let’s say the burnout levels are maybe dropping off.

What happens is that those parts of ourselves that are really valuable resources, the experiences that we had that are really almost like beautiful experiences that we had in the past, we suddenly start to remember them and we suddenly start to be able to access some of those earlier joys, some of that earlier playfulness and creativity. It’s a really profound realization that when we get traumatized by some of our experiences, it’s almost like the wisdom of our inner system puts some of those beautiful resources away for safekeeping until it’s safe to let us experience them again.

I’ve done work with clients where we’ve done some of that unburdening, and then they’re like, “Well, I’m just remembering this really beautiful time that I had with my siblings when I was younger”, and we can start to nurture that experience and really use it as a resource that reminds us of really happier times. It’s just an incredibly profound experience as we are recovering.

Paula: Yes. I can think of times when people I’ve worked with have, as you said, started to reconnect with patients or colleagues or achievements at work that have, as you said, really been meaningful and joyful. It’s like they were hiding away, exactly as you said, until it was safe to come out.

Wendy: It’s profoundly moving when that happens, you realize not all was lost.

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Paula: Thank you for listening. If you enjoyed this episode, and you’d like to help support the podcast, please do share it with others. Post about it on social media, or leave a rating and review. I’d love to connect with you, so do come and find me on LinkedIn or Twitter. You can also sign up to my mailing list to keep up to date with future episodes, and get useful psychology advice and tips straight to your inbox. All the links are in the show notes. Thanks again, and until next time, take good care.

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