Webb Therapy Uncategorized Continued guilt, shame, and internalised stigma correlated to alcohol and other drug use

Continued guilt, shame, and internalised stigma correlated to alcohol and other drug use

Despite significant advancements in political and health initiatives by governments and non-governmental organisations, shame, stigma, and internalized stigma continue to profoundly impact millions of lives worldwide. These negative perceptions and self-judgments can lead to feelings of worthlessness, self-blame, and social withdrawal, which in turn hinder access to services and participation in treatment.

Shame and stigma are particularly prevalent among individuals with substance use disorders, mental health conditions, and those experiencing psychosis. For instance, internalised stigma can lead to low self-esteem, depression, and hopelessness, which significantly impede recovery and emotional well-being. Even with the implementation of cognitive therapy and other supportive measures, the battle against internalised stigma remains ongoing in a similar fashion to intergenerational trauma, as though it has been built into human DNA.

Political and health initiatives have attempted to be instrumental in addressing these issues. For example, the Australian Government Department of Health and Aged Care has launched numerous programs aimed at improving health outcomes and reducing stigma. These initiatives focus on health promotion, early intervention, and disease prevention, aiming to create supportive environments for those affected by stigma.

However, the persistence of shame and stigma highlights the need for continued efforts to combat these issues especially in the workplace and within individual families. Addressing stigma therapeutically, promoting empathy and non-judgmental attitudes, and supporting individuals to view themselves beyond their conditions are crucial steps in mitigating the negative impacts of stigma.

Helping someone with a substance use disorder (SUD) while protecting yourself and your family involves a delicate balance of support and self-care. Here are some steps you can take:

1. Educate Yourself

Understanding SUD and its effects can help you make informed decisions and provide better support. Reliable sources include medical professionals, reputable websites, and support groups.

2. Set Boundaries

Establish clear boundaries to protect your well-being. This might include rules about substance use in the home, financial support, and personal interactions. Boundaries help prevent enabling behaviours and reduce stress.

3. Practice Self-Care

Taking care of yourself is crucial. Engage in activities that bring you joy and relaxation, such as exercise, hobbies, or spending time with friends. Self-care helps you maintain your mental and emotional health.

4. Seek Support

Join support groups like Al-Anon or seek therapy to process your emotions and develop coping strategies. Connecting with others who are going through similar experiences can provide invaluable support and understanding.

5. Encourage Professional Help

Encourage your loved one to seek professional help, such as counselling, therapy, or medical treatment. Treatment programs often include individual, group, or family therapy sessions, which can be beneficial for everyone involved.

6. Detach with Love

Detaching with love means setting emotional and psychological boundaries while still offering support. This approach helps you avoid becoming emotionally drained and allows your loved one to face the consequences of their actions.

7. Be Patient and Compassionate

Recovery is a journey that takes time. Be patient and compassionate with your loved one and yourself. Celebrate small victories and stay hopeful.

8. Avoid Judgment

Avoid being judgmental when discussing substance use. Offer support and understanding instead of criticism, which can help reduce feelings of shame and stigma.

References

Al-Anon Family Groups. (n.d.). Al-Anon and Alateen. Retrieved from https://al-anon.org/newcomers/what-is-al-anon-and-alateen

Australian Government Department of Health and Aged Care. (2024). Initiatives and programs. Retrieved from https://www.health.gov.au/about-us/what-we-do/initiatives-and-programs

Australian Institute of Health and Welfare. (2024). Health promotion and health protection. Retrieved from https://www.aihw.gov.au/reports/australias-health/health-promotion

Australian Government Department of Health. (2019). Alcohol and other drugs – Information for families. Retrieved from https://www.health.gov.au/resources/collections/alcohol-and-other-drugs-information-for-families

Mental Health Foundation. (2016). How to cope when supporting someone else. Retrieved from https://www.mentalhealth.org.uk/publications/how-cope-when-supporting-someone-else

Morrison, A. P., Birchwood, M., Pyle, M., Flach, C., Stewart, S. L. K., Byrne, R., Patterson, P., Jones, P. B., Fowler, D., & Gumley, A. I. (2013). Impact of cognitive therapy on internalised stigma in people with at-risk mental states. The British Journal of Psychiatry, 203(2), 140-145. https://doi.org/10.1192/bjp.bp.112.112110

National Institute on Drug Abuse. (2020). Family support in addiction recovery. Retrieved from https://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/family-support-in-addiction-recovery

Substance Abuse and Mental Health Services Administration. (2015). Substance use disorders. Retrieved from https://www.samhsa.gov/find-help/disorders

Wood, L., Byrne, R., Burke, E., Enache, G., & Morrison, A. P. (2017). The impact of stigma on emotional distress and recovery from psychosis: The mediatory role of internalised shame and self-esteem. Retrieved from https://repository.essex.ac.uk/21927/1/woodpr2017.pdf

Your Room. (2021). Shame and self-stigma. Retrieved from https://yourroom.health.nsw.gov.au/whats-new/Pages/Shame-and-self-stigma.aspx

Related Post

Are you feeling Restless, Irritable, and Discontent?Are you feeling Restless, Irritable, and Discontent?

I would infer that you may be depleted in some area of your life. Generally, when I am having any of these experiences I can recognise that my basic needs, and possibly even transformative, needs are not met. My basic needs are food and water, adequate sleep, shelter and safety, social connection (belonging), and esteem needs (e.g., self-respect, self-worth, self-competence, mastery and achievement, integrity, sense of freedom and independence etc.). Perhaps only when all my deficiency needs are met, and I’m experiencing dissatisfaction with my growth needs, do I feel Restless, Irritable, and Discontent in this area of my life – however I assume some would argue that if I am feeling that way when attending to my growth needs, then I may have slipped back to Esteem Needs. You can look up Maslow’s Hierarchy of Needs for a visual representation if you like, using a search engine. Below is a GIF that I created to educate people on how we can buffer ourselves to vulnerabilities. It’s very telling to go into the body when we haven’t eat for a while, may be we’re running on caffeine, and you can feel the restlessness in the body. We have to fuel up when we’re hungry to buffer ourselves from becoming irritable and restless. If you’re feeling discontent with life, I would suggest a social activity, play time with friends, working on a project of some kind, or getting involved in your community.

Fact. Truth. Belief. They are related but distinct. Here’s a clear explanation showing how they differ and interact:Fact. Truth. Belief. They are related but distinct. Here’s a clear explanation showing how they differ and interact:


1. Fact

Definition:
A fact is something that is objectively real and can be proven to be true. It exists independently of what anyone thinks or believes.

Example:

  • It is a fact that Australia is in the Southern Hemisphere.

Key Points:

  • Facts don’t change based on opinion.
  • They can be verified with evidence (e.g. scientific data, observation, reliable records).
  • Facts are the foundation upon which truth claims and beliefs can be tested.

2. Truth

Definition:
Truth is a quality of a statement or belief that accurately reflects reality or fact.

Example:

  • “Australia is in the Southern Hemisphere” is a true statement because it corresponds with the fact.

Key Points:

  • Truth depends on alignment with facts.
  • Truth is often expressed in language or claims (“That’s true”, “That’s not true”).
  • Something can be true even if no one believes it (e.g. the Earth orbited the Sun even when most people thought otherwise).

3. Belief

Definition:
A belief is something a person thinks or accepts as true, whether or not it actually is.

Example:

  • Someone might believe that kangaroos can be kept as pets in all Australian states — but that belief isn’t necessarily true or factual.

Key Points:

  • Beliefs are subjective — they vary between individuals and cultures.
  • A belief can be true or false, depending on whether it aligns with facts.
  • People often act based on their beliefs, regardless of whether they are accurate.

How They Interact

  • A belief can be true or false:
    → If your belief aligns with fact, it’s true.
    → If not, it’s false — even if sincerely held.
  • Truth depends on fact:
    → A statement is true if it correctly describes a fact.
  • Facts stand alone:
    → They are not changed by belief or opinion.

Internal Family Systems Therapy: Working with the Parts of OurselvesInternal Family Systems Therapy: Working with the Parts of Ourselves

Introduction

There is a moment in therapy that many practitioners recognise — the moment a client says something like, “Part of me wants to leave the relationship, but another part is terrified of being alone,” or “I know I shouldn’t be so hard on myself, but I can’t seem to stop.” These are not signs of ambivalence or contradiction. They are the natural language of a mind that is, at its core, multiple.

Internal Family Systems (IFS) therapy, developed by American psychotherapist Richard Schwartz in the 1980s, offers a sophisticated, compassionate framework for understanding this inner multiplicity. Rather than treating internal conflict as pathology or weakness, IFS recognises that the human psyche is composed of distinct “parts” — each with its own perspective, feelings, motivations, and history. Far from being a burden, this internal family can become, through careful therapeutic work, a source of extraordinary resilience and self-understanding.

This article explores IFS therapy in depth: its theoretical foundations, its core concepts, how it aligns with and enriches other established therapeutic approaches, and why working with parts has become one of the most generative developments in contemporary psychotherapy.


The Architecture of the Inner World: Core IFS Concepts

The Self

At the heart of IFS is the concept of the Self — a capital-S, differentiated Self that is not a part but rather the core of who we are. Schwartz describes Self as characterised by what he calls the “Eight Cs”: curiosity, calm, clarity, compassion, confidence, creativity, courage, and connectedness. In a well-functioning psyche, Self leads the internal system with warmth and wisdom, much as a skilled and attuned parent might lead a family.

Crucially, IFS holds that Self is never damaged, even in the most traumatised individuals. It may be buried beneath layers of protective activity, but it is always there — always intact, always available. This is a radical and profoundly hopeful premise, and one that resonates deeply with strengths-based and person-centred traditions.

The Parts

IFS identifies three broad categories of parts:

Exiles are the youngest, most vulnerable parts of the psyche. They carry the emotional weight of painful past experiences — shame, grief, terror, humiliation, abandonment, worthlessness. Exiles are often frozen in the moment of the original wound, experiencing distress as though it is happening right now. Because their pain is so intense, the rest of the internal system works hard to keep them hidden, suppressed, and out of conscious awareness. The system exiles them to protect the individual from being overwhelmed.

Managers are the proactive protectors — the parts that work day-to-day to keep exiles contained and maintain a functional life. They might appear as the inner critic who drives someone to perfectionism, the hypervigilant part that constantly scans for danger, the pleaser who never says no, the workaholic who stays perpetually busy, or the intellectualiser who processes everything through logic to avoid feeling. Managers are often the parts clients first present with in therapy. They can be harsh, relentless, and deeply self-critical — but they are acting out of care. They are trying to prevent the exile’s pain from surfacing and disrupting the person’s life.

Firefighters are the reactive protectors who spring into action when an exile’s pain does break through — when a trigger cuts past the managers’ defences. Their methods are urgent and often extreme: dissociation, substance use, bingeing, self-harm, rage, sexual compulsion, suicidal ideation. Like emergency workers who will break down a door to stop a fire, firefighters care little for collateral damage. They want the pain stopped, now. What might look from the outside like destructive or self-defeating behaviour is, from the inside, a desperate act of protection.

The Burden

IFS introduces the concept of burdens — the extreme beliefs, emotions, and somatic experiences that parts carry as a result of trauma or adverse experience. A part might carry the burden of worthlessness, of being too much, of being fundamentally unlovable, of needing to be perfect to be safe. Burdens are not intrinsic to the part — they were taken on, often in childhood, and can be released through therapeutic work. This process, known as unburdening, is one of the most moving and clinically significant moments in IFS therapy.


The Therapeutic Process: Accessing Self-Leadership

From Pathologising to Curious Partnership

One of the most significant shifts IFS invites is a fundamental change in how clients — and therapists — relate to symptoms. Rather than treating, suppressing, or pathologising parts, IFS invites clients to approach them with curiosity and genuine interest. What is this part trying to do for me? What is it afraid would happen if it stopped? This shift transforms the therapeutic relationship with internal experience from adversarial to collaborative.

This is deeply congruent with person-centred therapy as developed by Carl Rogers. The Rogerian conditions of unconditional positive regard, empathy, and congruence are, in IFS, extended inward — the client is invited to offer those same conditions to their own parts. The therapist models and facilitates an attitude of deep, non-judgmental curiosity toward even the most frightening or destructive-seeming aspects of the client’s inner world.

The U-Turn

IFS uses the evocative phrase “the U-turn” to describe the core therapeutic movement: from focusing attention outward (on external people, situations, or events) to turning inward and attending to one’s own parts. This is not a withdrawal from relationship, but a deepening of internal attunement that ultimately enriches external relating.

Working with Protectors First

A key technical principle in IFS is that therapists never attempt to work directly with exiles until protective parts have been acknowledged, understood, and have given permission. Attempting to bypass protectors — to push clients toward vulnerable material before the system is ready — risks overwhelming the client, reinforcing the protectors’ sense that they need to work harder, and potentially retraumatising.

This principle reflects trauma-informed care at a systemic level. Trauma-informed practice recognises that what looks like resistance is actually protection, that the body and mind have wisdom in their defensive responses, and that safety must precede exploration. In IFS, the therapist earns the trust of the protective system before asking it to step aside — and this is done with patience, respect, and genuine appreciation for the parts’ efforts.


IFS and Attachment Theory: The Inner Attachment System

Attachment theory, originally articulated by John Bowlby and extended by Mary Ainsworth and many others, holds that human beings are biologically wired for connection, and that the patterns of early caregiving relationships shape our internal working models of self and other. These models — secure, anxious, avoidant, disorganised — become templates for how we relate to ourselves and others throughout life.

IFS offers a compelling lens through which to understand these attachment patterns. A child who learned that their caregivers were unreliable or frightening may have a manager who vigilantly monitors others for signs of abandonment, and a firefighter who withdraws or rages when attachment fears are triggered. The exile at the centre of this system carries the original wound: the devastating belief that they are too much, not enough, or fundamentally unworthy of consistent love.

From an IFS perspective, insecure attachment patterns can be understood as the elaborate protective architecture built around early attachment wounds. The work of therapy is not simply to provide a corrective relational experience with the therapist (though this is important), but to help the client develop a secure relationship with their own internal system — to become, in a sense, a reliable and loving parent to their own parts.

This resonates with the concept in attachment theory of earned security — the idea that adults can develop secure attachment through reflective, attuned relationships, including therapeutic ones. In IFS, the therapeutic relationship with the Self becomes a primary vehicle for this.


IFS and Emotionally Focused Therapy: Accessing Primary Emotion

Emotionally Focused Therapy (EFT), developed by Sue Johnson and Les Greenberg, centres on accessing and transforming primary emotional experience as the key to therapeutic change. EFT identifies how people become trapped in negative interactional cycles — often driven by underlying attachment fears and needs — and works to create new, corrective emotional experiences within the therapeutic relationship or within close partnerships.

There is rich conceptual overlap between EFT and IFS. Both approaches recognise that:

  • The emotional reactions clients present with (often described in EFT as “secondary” or “instrumental” emotions) frequently protect against deeper, more vulnerable primary emotions.
  • Accessing and expressing primary emotional experience, in the context of an attuned, validating relationship, is transformative.
  • Defensive strategies and relational patterns make sense in the context of their developmental origins.

In IFS terms, the secondary reactive emotions — anger, contempt, numbness — are often the expressions of firefighter or manager parts, while the primary vulnerable emotions — terror, grief, shame — belong to the exiles. The EFT therapist and the IFS therapist are, in a meaningful sense, working toward the same goal: creating conditions in which the most vulnerable inner experience can be safely accessed, expressed, and received.

For practitioners integrating both models, EFT’s attention to the intersubjective, relational dimension of emotional experience complements IFS’s detailed intrapsychic map beautifully.


IFS and Trauma-Informed Care: Parts as Survivors

Modern trauma theory — shaped by figures including Bessel van der Kolk, Peter Levine, Judith Herman, and Pat Ogden — has fundamentally reframed our understanding of traumatic experience and its sequelae. Trauma is understood not as a historical event but as an unresolved physiological and psychological response that continues to shape perception, behaviour, and relationship in the present.

IFS is inherently and deeply trauma-informed. Several key principles align precisely:

Safety first. IFS protocol requires establishing safety with protective parts before approaching wounded exiles — this is trauma-informed practice enacted at a structural level.

Symptoms as adaptations. IFS reframes all parts, including those that drive the most problematic symptoms, as adaptive responses to overwhelming experience. This directly mirrors trauma-informed care’s understanding of symptoms as the body and mind’s best attempts to survive.

The body as part. IFS readily integrates with somatic approaches, recognising that parts often manifest in the body — the tight chest of a manager, the hollow ache of an exile, the rush of adrenaline of a firefighter. This aligns with Levine’s Somatic Experiencing and Ogden’s Sensorimotor Psychotherapy, which understand trauma as fundamentally embodied.

Avoiding retraumatisation. The IFS approach of never forcing or bypassing protective systems directly addresses the risk of retraumatisation that is central to trauma-informed care. The system is never pushed faster than it is ready to go.

Van der Kolk has noted in his own work that IFS offers one of the most effective frameworks for trauma therapy available, precisely because it honours the adaptive intelligence of the traumatised system while providing a clear pathway toward healing.


IFS and Strengths-Based Practice: The Innate Wisdom of Parts

Strengths-based approaches in psychology — drawing on positive psychology, solution-focused therapy, and narrative traditions — begin from the premise that clients possess inherent resources, capacities, and competencies that can be identified and amplified in service of wellbeing and change.

IFS is, at its core, profoundly strengths-based. Consider:

  • Every part, no matter how destructive its behaviour appears, is motivated by positive intent. The self-critical manager wants the client to be safe. The dissociating firefighter wants the client to survive. The exile, once unburdened, reveals not just pain but also energy, creativity, vitality, and joy.
  • The Self is understood as inherently healthy, wise, and compassionate — it is never broken, never the problem.
  • The goal of IFS is not to eliminate or control parts but to help them transform — to release their burdens and step into new, more constructive roles. Former managers may become trusted advisors; former firefighters may channel their protective energy more skillfully.

This sits comfortably alongside narrative therapy, which invites clients to identify their own preferred stories, values, and competencies, and to recognise that the problem is never the person — a belief IFS would extend to say that the problem is not even the part, but the burden the part carries.


Parts in the Consulting Room: Clinical Applications

The Inner Critic

One of the most common — and most clinically challenging — experiences clients bring to therapy is the inner critic: the harsh, often relentless internal voice that judges, shames, and attacks. Many therapeutic approaches attempt to challenge, reframe, or quieten this voice.

IFS invites a different approach: curiosity. What is this part trying to do? What is it afraid would happen if it stopped criticising? Almost invariably, the inner critic is a manager whose attacks are preemptive — better for me to shame myself than for others to shame me; better for me to be hard on myself than to become complacent and fail. Underneath the critic, there is almost always an exile who already feels deeply ashamed, and a fear that without constant vigilance, that exile’s shame would engulf everything.

When clients can approach the inner critic with curiosity rather than reactivity or resignation, something remarkable often happens: the critic softens. It is, at last, being seen. Its genuine care — however misguided its methods — is being acknowledged.

Polarised Parts

Clients frequently present with two parts in fierce opposition: the part that wants to leave a relationship and the part that is terrified to; the part that wants to rest and the part that drives relentlessly; the part that rages and the part that pleases. IFS understands these polarisations as a natural consequence of the parts system — each part pushes harder against the other in a bid to be heard, and the client gets caught in the middle, exhausted and immobilised.

The therapeutic work is not to choose a side but to witness and appreciate both parts, understanding what each is protecting and what burden each carries. When both parts feel genuinely heard — often, for the first time — they can begin to negotiate rather than fight, and a new, more integrated path often emerges organically.

Parts in the Body

Working somatically with parts is a natural extension of IFS practice. Clients are often invited to locate a part in the body — Where do you feel that manager? Where is the exile? — and to attend to it with curiosity. This somatic dimension both deepens access to parts and creates a felt, embodied quality to healing that purely cognitive work cannot achieve.

This reflects the insights of Sensorimotor Psychotherapy and somatic trauma work: that the body holds experience, and that healing requires the body’s participation, not just the mind’s.


The Therapist’s Parts: Working from Self

IFS has a distinctive and valuable contribution to make to therapist reflective practice. The model recognises that therapists, too, have parts — parts that may be activated by particular clients, content, or dynamics. A therapist’s rescuer part might want to fix a client’s pain. A manager part might become anxious in the presence of a client’s rage. A part carrying shame might be triggered by a client’s self-loathing.

IFS invites therapists to develop the same kind of Self-to-part relationship within themselves that they facilitate in clients. The goal is to work predominantly from Self — from that grounded, curious, compassionate centre — rather than from reactive parts. This is what makes authentic, attuned presence possible, and it is what clients most fundamentally need.

This resonates with concepts from relational psychoanalysis and interpersonal neurobiology around the therapist’s own embodied presence, attunement, and regulatory capacity as central to therapeutic change.


What the Research Tells Us

IFS has been formally recognised by the US Substance Abuse and Mental Health Services Administration (SAMHSA) as an evidence-based practice. Emerging research supports its effectiveness across a range of presentations including depression, anxiety, trauma symptoms, relationship distress, and chronic pain. Qualitative research consistently highlights clients’ experience of increased self-compassion, reduced internal conflict, and a greater sense of agency and coherence.

It is worth noting that the mechanisms of change in IFS (i.e., accessing and processing primary emotion, developing self-compassion, resolving internal conflict, processing traumatic memory) align with well-established change processes across multiple modalities. IFS does not work in spite of other evidence-based frameworks; it works, in significant part, because of the same underlying processes.


A Note on Integration

IFS is perhaps best understood not as a standalone modality but as a rich, generative framework that deepens and organises other therapeutic approaches. It sits comfortably alongside Acceptance and Commitment Therapy (whose defusion techniques offer another pathway to working with parts), Schema Therapy (whose modes bear striking resemblance to IFS parts), EMDR (which can be powerfully integrated with IFS for trauma processing), and Compassion Focused Therapy (which shares IFS’s emphasis on developing compassionate self-relationship).

For practitioners working across multiple frameworks, IFS offers what might be called a meta-map — a way of understanding the internal landscape that gives shape and direction to interventions drawn from many sources.


Conclusion: The Courage to Go Inside

Ultimately, IFS therapy is an invitation to curiosity over judgement, to compassion over shame, to relationship over exile. It asks clients to do something both simple and profoundly courageous: to turn toward their own inner world with the same warmth and interest they might offer a dear friend.

The parts of us that cause us the most distress are rarely our enemies. They are, more often, the oldest and most loyal parts of ourselves — still working, long after the need has passed, from strategies learned in more dangerous times. When we can see them clearly, appreciate their efforts, and help them lay down their burdens, what emerges is not fragmentation but wholeness: a richer, more spacious sense of self, capable of greater authenticity, deeper connection, and genuine wellbeing.


This article is intended for professional and educational purposes. If you are interested in exploring IFS-informed therapy for yourself, please speak with a qualified mental health practitioner.