Despair: what is “despair,” what does it mean, and why is it important?
The contents of this blog are my opinions and are not the opinions of any current or former colleagues. This is not to be construed as mental health or medical advice and does not constitute a relationship with a professional therapist.
There are a lot of therapy buzzwords, which at times can be useful, but also at times seem nebulous or hard to incorporate into actual therapeutic praxis. A few words that fit into this category for me are “acceptance” and “forgiveness.” If you tell me that you have accepted something, or have forgiven someone, I understand what you mean, but I’m not sure there is a concrete way to achieve these states of being or understanding.
Some therapy buzzwords become significant, therapeutic trending topics. The popularity of Bessel van der Kolk’s The Body Keeps the Score appeared to catapult the treatment of “trauma” into the therapy zeitgeist. It is worth noting that Judith Herman’s seminal Trauma and Recovery discussed historical periods in which this was also the case: the advent of psychoanalysis (over 100 years ago); related to wars, foreign conflicts, and soldiers who experienced “shell shock”; and the rise of feminism in the 1960s and 1970s, as women were more able to discuss and find support for intimate partner violence and sexual assault. Parts of me are on board with the importance of helping clients treat their trauma. I am currently reading Avgi Saketopoulou’s Sexuality Beyond Consent, and other parts of me somewhat align with her view of “traumatophilia.” Saketopoulou posits there is no return to the prelapsarian moment before the trauma occurred, that there is a current, cultural obsession with “overcoming” trauma, and it is worthwhile to examine what people do “with” their trauma, instead of pursuing ways to champion past it. I hope to finish her book in the very near future. It is a truly fascinating book, and I’d recommend it to you while the caveat that reading it has been somewhat triggering for me.
Other trending therapy topics which feel current, that have not quite reached the ubiquitous level that trauma treatment has, are “experiential avoidance” (an important topic, to be sure) and “interoceptive awareness” (a fifteen-dollar word for ‘’inner’ awareness, which, if you’d read any of my blog entries, one that is really important in my own therapy practice.)
A topic which I feel is underrepresented in clinical literature, and certainly at the level of any modern therapy trend, is the concept of “despair.” I recently (in about the last… two years) read a handout written by the IFS therapist Mike Elkin, and when I read it, it blew my socks off. Why? It resonated significantly in my mind with a subjective 75% of my then caseload. In other words, it appears to be a very common clinical concern. I believe Elkin wrote that handout in the 2000s. I will quote Mike in his definition of despair. If you look at his handout, you will see I copied and pasted half of it here:
“It is very common for parts to learn to embrace despair as a resource, and therefore, to
begin to see hope as a trap to be avoided. This can occur when a part is experiencing
unrelenting pain. At first the part makes determined attempts to find and execute
strategies to relieve the pain, but as these continually fail, the part begins to experience
these attempts as making things worse.
Every try at improving the situation fails, thus adding to the already excruciating chronic
situation the added pain of disappointment, and the shame of failure. Because a major
component of trauma is the feeling of helplessness, the part is desperate to feel that it
can have some impact on its situation. At some point, it discovers a way to feel some
sense of instrumentality: it decides to stop trying to make things better!
While the chronic pain remains, this decision lets the part experience the ability to end
the pain of disappointment, and the shame of failure. Cold comfort though it may be, it is
important to understand how much relief it can be for the part to feel that can effect its
circumstances. Once the part makes this decision, then hope and possible solutions will
be perceived as a trap exposing it to the danger of disappointment and shame.”
I would imagine that most therapists, and many clients have experience with despair, without perhaps naming it outright. Many clients report a core belief, or speaking from parts of them that are depressed, “things will never get better.” When a helpful therapist asks “have you considered alternative [x]?” or “have you thought about trying [y]?”, a client might immediately swat away consideration of the perspective or behavioral response. “That isn’t going to help (or work, or matter at all), nothing will!” Imagine having some version of that conversation every session, once a week, for a year, or longer. I’ve had clinical experience getting stuck in a polarization between my client’s despair, hopelessness, and negativity versus my “helpfulness.” Frankly, it is a tough place to be in as a clinician, which makes me stagger when I consider it from the client perspective. Imagine if any effort you think about making to improve your circumstances just brings more inner criticism, pain, and shame. I am reminded a bit of Pete Walker’s book Complex PTSD: From Surviving to Thriving; Walker describes clients he has worked with, with extremely abusive and invalidated childhoods, for whom even the thought of expressing a want or preference can trigger panic and emotional flashbacks.
It can be challenging to sit with our own and others’ hopelessness. As therapists, it is or can become vitally important to accept our clients just as they are. You are who you are, and you are bringing what you are bringing. More than that, the therapist Mike Elkin suggests Internal Family Systems therapy can be effective at helping our clients “unburden” their despair strategies. Their despairing parts don’t have to hold onto their despair ad infinitum. This can crucially important, because if we are successful at scraping layers off of that despair, it might just give clients the opportunity again to try and improve their circumstances. What a gift that could be.
Are Internal Family Systems therapy (IFS) and Acceptance and Commitment Therapy (ACT) therapeutic cousins?
The contents of this blog are my opinions and are not the opinions of any current or former colleagues. This is not to be construed as mental health or medical advice and does not constitute a relationship with a professional therapist.
I learned about Acceptance and Commitment Therapy (ACT) when I completed my clinical internship in my last year of graduate school, which was 2019-2020. I had a graduate professor, who I quite admired, who was my site supervisor for that internship. I was practicing in-home therapy with individuals diagnosed with serious and persistent mental illness (SPMI) for my clinical placement. My professor shared her fondness for ACT, and she felt (for reasons she did not elaborate on, that I can recall now) that I would be a good fit for practicing ACT. Her assessment turned out to be correct; most of my current clinical interests revolve around therapies that help us become more open and curious towards our inner experiences. I believe Internal Family Systems therapy, Acceptance and Commitment Therapy, and psychoanalysis share a common thread in this regard. Arguably, a lot of other modalities do as well (example: Somatic Experiencing), but I do not have the dearth of knowledge about them to make the same claim.
I purchased and read Russ Harris, M.D.’s book The Happiness Trap around that time (in the late winter of 2019.) Harris’ book appears to be directed towards laypeople and not clinicians, but I found it to be professionally (and personally) helpful. I recall practicing ACT skills on myself when I read through it, and utilizing those interventions in many of my earliest sessions as a clinician. I consider ACT to be a skill-based approach to psychotherapeutic treatment, which is useful when we are willing to practice its six core processes.
Fast forwarding five and a half years, I have taken numerous trainings in Internal Family Systems therapy. Lately, I have been wondering about the relationship between IFS and ACT. Practitioners of either discipline might staunchly disagree with me (my professional email is attached to my website if anyone wants to engage in a lively discussion about this), but I feel they can be closely related. I am fond of calling them “cousins.”
The Happiness Trap describes ACT as having six core processes.
1. De-fusion (or cognitive de-fusion)
2. Expansion
3. Contact with the present moment
4. The Observing Self
5. Value clarification
6. Committed action
De-fusion (or cognitive de-fusion) is the practice of noticing (or, attempting to notice) your thoughts without judgment. “I notice I am thinking [x]”, “there is that same story [x] again”, thanking your mind, or even just noticing and naming “thinking”, are all common de-fusion strategies. If we swap out “thoughts” with “parts,” this is not dissimilar from what we practice in IFS sessions, and what we might practice between our IFS sessions. As I discussed in my previous blog post, I try to remain curious about which part of us is doing the noticing (Self? A Self-like part? A thinker, or critic? How do we feel or react when we notice those thoughts? Curiously? Overwhelmed? With rage? Do we align exactly with what they are saying to us?)
Expansion is the practice of accepting and allowing (or attempting to accept and allow) our feelings. A common prompt here is to “observe, acknowledge, breathe, create space, and track.” The thought is when our tense or stuck feelings are given room to ‘breathe’, physiologically, they can become unstuck, process, and move on. A common prompt in a session of IFS is “would that part be willing to give you more space than it is giving you now?”
“Mindfulness” and “meditation” are both therapy buzz-words with thousands of different definitions. Both tend to support contact with the present moment. I recall reading in Richard Schwartz’s book No Bad Parts that he describes Internal Family Systems as “mindfulness plus,” basically mindfulness with the added component of engagement or interaction.
I was fortunate, in December 2023, to see ACT’s inventor Stephen Hayes, PhD give a presentation at a psychotherapy networking and training event in Anaheim, California. He excitedly shared his recent research findings. I also recall him speaking about de-fusion. Hayes explained that as we successfully begin to differentiate ourselves from our constantly running stream of consciousness, he said (and this is nearly verbatim) “there is this other version of you, this spiritual version of you, behind your eyes.” I believe he was talking about what ACT describes as “the observing Self;” IFS centers around the notion that we all have a non-part part of ourselves that Schwartz coined the Self, our inner openness, gratitude, compassion, curiosity, and so on. It is worth noting here that the psychoanalyst Donald Winnicott historically coined a term "false self", which “refers to a defensive persona developed to protect the vulnerable ‘true self,’ often shaped by early relationships and societal expectations.”
There is a bit more divergence between these two models with regards to value clarification and taking committed action. Common conversations in therapy offices often revolve around “core values.” ACT suggests that we connect to our core values and take committed action towards them, in other words it is important for us to “do what matters.” I believe IFS is helpful at clarifying our inner values; I believe that we can have parts which have differing sets of values (i.e. “a part of me thinks I should eat better and become healthier for my children, but another part of me is really interested in just turning the week off and eating a whole large Papa John’s pizza on Friday.”) I do not practice much behavioral therapy. I am not suggesting behavioral therapists are bad or awful people, I imagine they are (usually) good and helpful people, but I believe it is important to pay attention to our inner forces which might ‘keep their foot on the brake.’ Is it possible to negotiate with those forces, or obtain their permission which might allow us to take steps towards doing what matters to us?
I recently read an article which also supports the use of and intermingling of both modalities. I’ve learned that renowned therapists including Janina Fisher, PhD, and the aforementioned Harris, teach their clients to call out various ‘parts’ when they notice them. I believe that using IFS and ACT in coordination can help achieve the goals both models strive for, which include increased psychological flexibility and the processing of our traumatic and shameful material (which is another great therapy buzz-word, “healing;” Bruce Ecker describes this process as “memory consolidation”.)
Final note: I recently finished reading Paul Williams’ book Invasive Objects: Minds Under Siege. I found it to be an exhilarating read, and intended to create a blog entry about it. The blog entry proved to be much less exhilarating than the text, which led me down the ACT and IFS rabbit hole afterwards. It might see the light of day at some point in the future, or I might give those parts of myself permission to let it go. I am learning that attachment theory appears to be a newer version of object relations.
Internal Family Systems therapy and Dialectical Behavioral Therapy: a primer.
The contents of this blog are my opinions and are not the opinions of any current or former colleagues. This is not to be construed as mental health or medical advice and does not constitute a relationship with a professional therapist.
When I was a much newer therapist, I spent a decent amount of my in-session time teaching my early clients “how to breathe.” I suspect that newer therapists do so for various reasons, three of which are: 1) it is easy to do, 2), it can fill time when spending time with clients who are not very loquacious, and 3) it helps resolves the therapist’s discomfort with their client’s in-session distress. I also suspect that as many therapists become more seasoned, they develop more tolerance for the distress of their clients and have much less inclination to try and immediately resolve in-session distress or “fix” problems for their clients. That has certainly been my experience over the last five years. To be fair, when I was in graduate school, I saw an EMDR therapist who I believed had thirty years of experience (give or take, it was near their retirement), and I recall them teaching me breathing strategies early on in our time together. EMDR therapists might describe that practice as “resourcing.”
There are hundreds of varieties of “how to breathe.” Common examples include “square” (or “box”) breathing (4, 4, 4, 4.) I also historically taught clients “polyvagal” breathing (4, 8; other sources online describe this as 4, 7, 8); I had read an article online (written by a polyvagal-informed therapist who struggled with insomnia, I had trouble locating it during the writing and editing of this blog entry) that suggested that taking 5 breaths a minute for two minutes had the effect of calming our vagus/vagal nerves, which are in our stomachs. One of my critiques of teaching prescriptive breathing practices is that everyone’s body is different; what feels calming to me might not be relaxing for you, for reasons based in our differing physiologies.
I have two very distinct memories of spending time with clients who reported significant in vivo anxiety. “Let’s work together on some breathing,” I would helpfully offer. In both instances, the clients reported to me I was making them feel more anxious. “Breathing is supposed to make us feel less anxious!” I thought at the time. As I have come to understand our psyches as a collection of parts that form a more composite self (lower-case “s” self), I retroactively developed the theory that my clients’ anxious parts felt we were trying to suppress or mitigate them, as opposed to soothing or supporting them. It makes sense, then, that they would turn the volume up, when faced with an oppressive outside agency. Our anxious parts are quite good at turning their anxiety up when the need arises. Ask anyone who spent some time ignoring their generalized anxiety parts who later encountered those parts as panic parts.
I was sitting with a client much more recently and shared my developing theory with them. They said they had practiced breathing historically, and affirmed my theory by wondering if their anxious parts felt suppressed by them (per their report, the breathing practices had not been very effective at calming their anxiety.)
My grand takeaway from these experiences has been that breathing practices should be negotiated with the parts of us they are designed to impact. Can we work with our clients’ anxious parts to soothe and support them, to offer them co-regulation? I have developed a similar perspective towards the instruction of therapeutic “skills.”
I believe there are some overlapping features between Internal Family Systems therapy (IFS), and Dialectical Behavioral Therapy (DBT.) My Artificial Intelligence assistant provided me a brief synopsis on DBT and its origins:
Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral therapy (CBT) developed to help individuals manage intense emotions, reduce self-destructive behaviors (like self-harm or suicidal thoughts), and improve relationships. It emphasizes the balance between acceptance and change, teaching skills in four main areas:
Mindfulness – staying present and aware.
Distress Tolerance – coping with crises without making things worse.
Emotion Regulation – understanding and managing intense emotions.
Interpersonal Effectiveness – navigating relationships and asserting needs.
DBT was created in the late 1980s by Dr. Marsha Linehan, a psychologist at the University of Washington. It was originally designed to treat individuals with borderline personality disorder (BPD), many of whom experienced chronic suicidal ideation. Linehan developed DBT after realizing that traditional CBT was too change-focused and often invalidating for people with extreme emotional sensitivity. By incorporating acceptance strategies (inspired by mindfulness and Zen practices), DBT provided a more compassionate and effective approach.
From my perspective, some of the overlap between IFS and DBT includes that both therapies attempt to address polarities. IFS helps therapists and clients work with “polarized parts” (that is, the parts inside of us with wildly different perspectives about what is best for us and with opposing strategies for helping us), while DBT employs dialectics to reduce swings from various extremes and helps move clients towards the middle from black and white thinking. Another overlap is that DBT promotes that we must first accept ourselves to be able to change (a paradox, and an intentional or unintentional nod to the great Carl Rogers); we find in IFS that parts have a challenging time changing when they are under constant scrutiny by hyper-analytical, demanding, critical, or suppressive parts.
Circling back to the negotiation of skills, a common emotional regulation skill in DBT is the TIPP skill (temperature, intense exercise, paced breathing, and progressive muscle relaxation.) Again, as a brand-new therapist, I loved teaching clients this skill, because I felt the temperature portion of TIPP can be useful for self-harm, panic, blind rage, dissociation; really any situation in which I could ask a client to remember they could put an ice cube on their neck, face, or clutch an ice cube tightly in the palm of their hand. When I was teaching clients this skill, which part of them was I asking to learn the skill? Which part was I asking them to “treat” with it? I assume that my client’s logical part was sitting with me in those sessions, and we were hoping to reduce behaviors and experiences associated with what in IFS we describe as “firefighters” (in IFS, firefighters are our reactive parts, who hope to “put out the emotional fire”; they often get most of the clinical press and attention, because they often arouse the greatest concern in the therapist parts of their treating providers.) What if a client could negotiate an arrangement between their skill-learning logical parts and the parts of them that probably don’t love the feeling of being so out of control? Years ago, my clients often gave me mixed reviews of the TIPP skill (some found it to be helpful, sometimes, and some recognized that after TIPP was applied, the pesky “issue” we were working on was not all that different. It just kept happening.)
Another common skill in DBT is the DBT Observe skill (which I had always learned of as DBT Observe and Describe, and a former client taught me the acronym Observe/Describe/Participate.) DBT O/D feels closer in application to IFS therapy than many of the other DBT skills I am familiar with. It also reminds me a lot of “observing and acknowledging” in Acceptance and Commitment Therapy (ACT; the overlap between ACT and IFS will be the subject of a future blog entry from me.) A brief synopsis of DBT O/D is:
The DBT Observe skill is a fundamental component of Dialectical Behavior Therapy (DBT) that focuses on cultivating mindfulness. It involves noticing and paying attention to your thoughts, feelings, and surroundings without judgment or reaction. This skill is essential for developing a nonjudgmental relationship with your experiences, promoting emotional balance, and enhancing awareness. Practicing the observe skill can include exercises such as observing your environment, sensations, or even your thoughts without labeling them. Overall, it serves as a foundational practice for greater insight and emotional regulation in DBT.
An important consideration for DBT O/D is, who (or which part of us) are we asking to observe? Can our clients observe their experiences from a non-judgmental and/or non-reactive place? IFS helps our clients address this potential barrier by asking a client’s judgmental or reactive parts for space. It can be hard to non-judgmentally observe your critical voice when you feel overly criticized and beleaguered by it. It can be hard to passively and non-judgmentally observe other inner experiences when you feel triggered, overwhelmed, or disconnected from yourself.
I was recently reading an article by Martha Sweezy, PhD; Dr. Sweezy is an author and editor of IFS books. In her article she proposes that DBT is a Stage 1 treatment before clients move towards a Stage 2 trauma treatment (she proposes the use of IFS here, but acknowledges other evidence-based trauma treatments as well.) Sweezy suggests that as clients advance through DBT treatment and towards graduation, that they begin to apply concepts from both therapeutic models:
“As the patient achieves sufficient affect regulation in DBT to be able to focus on trauma, the therapist introduces the patient to concepts shared by DBT and IFS and, during sessions that follow, the therapist points out how these shared concepts are being operationalized experientially for the patient. The goal is to use shared concepts to bridge the learning based approach of DBT in Stage 1 into the next phase of treatment, emotional experiencing.” (p. 92)
There are a lot of skills I have picked up over the years which I feel could be of benefit to clients who are willing to practice them. I believe we can provide our clients with more productive, meaningful, and compassionate care, when we can assist them with negotiating the implementation of therapeutic skills between their parts and in their inner experience. A question I am fond of asking during IFS insight work with my clients is: “can these parts see that they are actually on the same team?”
What difference would it have made in your life if you had been your own parent?
It all begins with an idea.
The contents of this blog are my opinions and are not the opinions of any current or former colleagues. This is not to be construed as mental health or medical advice and does not constitute a relationship with a professional therapist.
“How do you imagine your life might have been if you’d had yourself as a father or mother?”
That’s from David Denborough’s Retelling the Stories of Our Lives: Everyday Narrative Therapy to Draw Inspiration and Transform Experience (p. 197.) I was reading an article by a Noam Shpancer, Ph.D. on Psychology Today a while back (“The Most Important Question in Therapy.”) I am prone to hyperbole, but I feel Denborough’s question is one of the most important questions we can ask of our clients, and one of the most important questions we can ask of ourselves. Denborough asks another important question in the same section: “If you’d had yourself for a mother or father, what would you have appreciated about yourself as a child that wasn’t appreciated in you as a child or adolescent?” (p. 197.)
What difference would it have made in your life if you had been your own parent? I’ve had clients tell me they would not have allowed themselves to be sexually abused as children for years; I’ve had other clients tell me they would have been able to talk about their disordered eating and find support in doing so; I had one client say to me “I’m not going to answer that bullshit science fiction question.”
I’m nearly finished reading Paul Williams’ Invasive Objects: Minds Under Siege. Paul Williams is a psychoanalyst; in his book he discusses a client with a highly traumatized childhood who engages in analysis for years with Williams. “After some years of analytic work, James said to me: ‘I feel I have to pay attention every day to that child I was. It’s like visiting someone in hospital or a grave. If I don’t think of him or hold his hand, I feel lost. I will never let him go again.’” (p. 161). Williams’ client is engaged in long-term psychoanalytic therapy; it appears this has given him the ability to do what Internal Family Systems therapy refers to as “parts work” (or, sometimes, “ego state therapy.”)
Notably, the Adult Children of Alcohlics and Other Dysfunctional Families 12 Step support group (ACA, sometimes stylized as ACoA, which I prefer less) also eventually focuses on what they describe as “reparenting” and learning to treat yourself with “gentleness, humor, love and respect” as opposed to harshness, rigidity, self-deprecation, etc.
I have a significant interest in and continue to pursue training in Internal Family Systems therapy. Internal Family Systems proposes that we have protective parts that protect us from our wounded inner children (“exiles”, in IFS parlance), and that we have a core Self which can help heal those wounded children. I regularly consult with a therapist who explains that Self’s superpower is the ability to remove moral meaning from our experiences. Denborough and Williams, despite being involved in different schools of therapy, both appear to suggest something very similar. What if we could learn to treat ourselves with curiosity, compassion, and respect? What if we could learn to tend to the hurt parts of our pasts?
When we enter therapy, we hope to begin to develop a new relationship with ourselves, a new relationship to our histories and heartbreaks, and with a little bit of determination and luck, a new relationship with our futures.
My perfectionistic parts want me to let you know I wrote this on Monday, June 16th, 2025, not May 28th. Ha!