Why use IFS for OCD?

Those of us who have specialized in treating OCD know that exposure therapy works and that it does not have to be a horrible traumatizing experience when done with a compassionate and skilled therapist. I personally have met thousands of people at conferences who have their lives back because of good treatment rooted in exposure and response prevention. In fact, many of my colleagues are individuals who have OCD and were inspired by their own treatment to become therapists and help others. These are some of the most compassionate and courageous people I know. Part of the challenge with OCD is that it is complex and multi-faceted. Even with the best intentions, family members and even clinicians can easily fall into the trap of reinforcing symptoms and making OCD worse. Exposure therapy with response prevention (ERP) is the frontline treatment, and it is highly effective for OCD and related anxiety disorders. However, despite the well-documented research and evidence of its efficacy, ERP does have limitations and drawbacks. Exposure to compulsion triggers can be unpleasant, even traumatizing, and for individuals who have had some form of trauma, it may not be therapeutic.

There is also a perception that ERP doesn’t always work and that many of those who experience relief find that symptoms recur, or surface later in another domain. Finally, some people are just not willing or have tried it and have not made progress.

Internal Family Systems is an approach to therapy that addresses some of these drawbacks without compromising the effective exposure mechanism. Most therapists recognize that OCD does not respond well to talk therapy. Rather than being analyzed, understood, or explored, OCD requires a present-moment, therapeutic encounter. In ERP, clients are taught to face their fears and to be with them rather than engage in neutralizing safety behaviors. Internal Family Systems employs the same experiential process, but in a much more nuanced and compassionate way. In my research and practice, I began to see a strong connection between the approaches and developed a treatment protocol that utilizes IFS based on the healing elements common to both methods, the experience of encountering parts of ourselves that would have been trying to avoid. My approach is the consolidation of my research and experience, catalyzed by my daughter’s journey and inspired by the many courageous clients I have been fortunate enough to accompany on their path toward freedom from OCD. I believe it will make recovery possible for many individuals who are not able or willing to do traditional ERP, and it will prevent many from experiencing the treatment aversion that keeps them from engaging in therapy after ERP.