Inside the Revolutionary Treatment That Could Change Psychotherapy Forever
Inside the Revolutionary Treatment That Could Change Psychotherapy Forever
IFS therapy is upending the thinking around schizophrenia, depression, OCD, and more

The problem is much bigger than schizophrenia. All too often, patients in today’s U.S. mental health system fall into a downward spiral of increasing diagnoses and increasing medication. As journalist Robert Whitaker reported in his controversial classic Anatomy of an Epidemic, the number of people on government disability for mental illness has actually increased since the introduction of Xanax, Prozac, and other drugs that were once billed by pharmaceutical companies as a panacea for mental health. Though psychiatric medications have brought relief to millions of patients, the impact of long-term use of many drugs is only starting to become clear: chemical dependency, mounting side effects, and fundamental changes in the neurochemistry of the brain. For patients with a diagnosis of schizophrenia, the effect is particularly severe. Numerous studies have found that schizophrenics fare worse on long-term antipsychotics, though it remains the standard of care. Ross was teetering on the edge of a long, steep hill that ended in near-total dependency: on daily meds to manage symptoms, on hospitals to arrest full-blown psychotic episodes, and likely on disability checks to provide for a living. (He had already begun the process of applying.)

Medeiros, Ross’s therapist, didn’t want that to happen. He had known Ross since age 11, when his parents had first brought him in for germophobia, and couldn’t help believing that the warm, quirky kid he remembered lay somewhere inside the shell-shocked guy who now showed up each week in his office. But nothing Medeiros had tried seemed to be getting through. Ross kept ending up back in the hospital and coming out even more wary and cut off.

On the day after the 2016 presidential election, terrified by what it meant for the country, Ross slipped into psychosis yet again, wandering into the courthouse downtown and making a scene before the police finally hauled him off to the hospital. This was the fourth hospitalization in two years, and Medeiros was running out of options. At a loss for what else to do, he decided to try something radical: a novel therapeutic model called internal family systems therapy (IFS).

All too often, patients in today’s U.S. mental health system fall into a downward spiral of increasing diagnoses and increasing medication.

IFS had recently been the subject of a lot of chatter in the psychotherapy community. It was based on a novel theory of the mind so profoundly at odds with the biomedical model of mental illness that, if true, called decades of clinical orthodoxy into question. In IFS, mental health symptoms like anxiety, depression, paranoia, and even psychosis were regarded not as impassive biochemical phenomena but as emotional events under the control of unconscious “parts” of the patient — which they could learn to interact with directly.

Medeiros had only been undergoing IFS training for a year and didn’t feel ready to do more than some preliminary exploratory work with Ross. But he had some idea who could help: Richard C. Schwartz, PhD, the developer of the therapy, whom Medeiros had had the good fortune to meet in person back in June 2016. When Schwartz appeared on the lineup for a trauma conference in Chicago, Medeiros signed up with the hope of speaking to him again. Nearly holding his breath with anxiety, Medeiros found an opportune moment to seek Schwartz out and explain Ross’s case. Schwartz listened intently.

“Why don’t you bring him to Boston to see me?” Schwartz said.

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