What follows is a piece I wrote recently in an attempt to introduce IFS to people experiencing BIID. What is common amongst these folks is that the obsessive desire for amputation occurs prior to adolescence and so it strikes me as being a blended firefighter. The belief that the limb requiring removal does not belong to them had led sufferers to blow their own legs off with a shotgun, or encase them overnight in dry ice etc. I would be very interested in other IFS therapists' perspectives on this and would like to know if anyone has any connections to people working in this area.

Derek.

Recently while watching the documentary "Whole" I was struck by the tremendous suffering
experienced by many of the interviewees who both knew that wanting to have a
limb amputated was "crazy", yet held the belief that it was the only way they
could experience peace of mind. Many had attempted to resolve what was going on
therapeutically to no avail and the years of desperation, feeling like they were
living inauthentically, disruption to their families and felt sense of stigma
spoke to a painful and invisible outsider status.

As a psychotherapist I could appreciate how traditional psychotherapy had failed
these folks. Attempts to change thinking, alter behaviour, essentially to
control and manage the "condition" are doomed to fail – and even generate
greater feelings of low self-worth and desperation as repeated failures
reinforce the "inability" to do anything about it.

Nonetheless I want to suggest that therapy may be able to offer hope for
resolution of the tensions of living with BIID without resorting to the radical
solution of surgery. My intent here is not to judge nor condemn those who choose
and continue to advocate for surgery; merely to offer another item on the menu.

My teenage desire to find out why I was so screwed-up, coupled with intense
shame about it, led me to study psychology. Smart kid that I was I figured out
that I could find out what was wrong with me without having to tell anyone.
Years of study at university left me none the wiser, so I engaged in further
training in psychotherapy. This at least offered some answers: these bad things
happened to you, they've left a terrible stain on you, learn to live with the
stain. There was some comfort in this as I proceeded to make my way in the world
helping others to identify and live with their stains.

But something was lacking in this understanding for me. Surely this couldn't be
it? So I continued to pursue different avenues of enquiry, eventually landing on
IFS – the Internal Family Systems approach to therapy. I'd read some books by
this guy Dick Schwartz that made sense to me, then discovered that he ran a
retreat in Mexico in February for a week. I live in Canada and a week in Mexico
at that time of year as a tax write-off is very appealing. As I sat on the plane
contemplating a lonely time without my 3 year old daughter but relieved at not
having to deal with her mother with whom I'd been fighting for a long while, a
voice in my head screamed, "Are you nuts? You're going to be trapped with a
bunch of strangers for a week doing group therapy every day – what were you
thinking?" "You're bringing this up now?" another voice replied.

During the week of lectures, practice and personal work I realised this guy was
on to something. What makes his approach revolutionary is that he recognises
that the personality operates as a system, with different parts of the system
taking different roles. Some parts have extreme feelings and beliefs and are
"exiled" out of the system by other parts seeking to protect us from them. When
those vulnerable parts get triggered other parts jump up to distract us from
them, and these protective parts are termed "firefighters"; using TV, sleep,
alcohol, drugs, sex-bingeing, food bingeing, rage etc to keep the system
occupied until the vulnerable parts retreat again.

These parts and their patterns and dynamics tend to get set early in life. A
woman violated by a man as an 8 year old child who was not helped through it at
the time will have both a violated and hurt part of the system and a protector
part saying "Don't trust men." At 8 years old this black and white view makes
total sense. When this strategy plays out in one's thirties however it can be
bewildering. She may find that she cannot find a man she can trust – and that is
because, in a sense, there is an 8 year old making her dating decisions.

Central to this understanding of how we function is that there are no bad parts
– just parts of the system forced into extreme roles. When we are able to bring
understanding and compassion to these parts they may be able to relinquish these
roles. The question arises, however, if we consist of all these parts, who is
the one bringing compassion? The final element in this system is the
understanding that we also are a Self. In this system Self is seen as a
qualitatively different entity from the parts. Self has qualities of:
compassion, curiousity, calmness, creativity, connectedness and clarity (amongst
others) and is able to engage with the various parts of the system. When the
Self does that then parts holding distress no longer need to be managed
(minimized, shamed, dismissed) or avoided (just have another drink) but can be
heard, validated, and invited to release the pain they hold.

This was the first time in all my years that I had come across an understanding
of the personality - as a system – that both made sense and offered realistic
hope for change. As I became aware of the part of me (firefighter) demonizing my
co-parent and I calmy asked it about the part it was protecting I saw the little
kid that felt scared and smothered by her attention. And how helpless that had
been to defend itself from its mother. As I truly listened to how hard it was
for that kid – asking another part saying, "Oh please, suck it up" to step aside
- it was able to release what it was holding. My raging protector part was then
able to settle down, and I was safe to open again to how important this person
is in my life and my deep feelings for her.

Returning home I changed my private practice to one using the IFS method. I
recognised that my addicted clients had a part leading the charge in wanting to
eradicate the (protective) substance-using part – and that I had a therapist
part that had been colluding in that perspective. My abused clients had
desperately wounded young parts buried beneath layers of minimising protectors.
My depressed client had a depressed part scared about what would happen if it
withdrew control (specifically that she'd realise how dull her husband was and
have to leave him). Each client was able to access parts of themselves that were
informing their distress and move towards permanent change and greater calm by
helping those parts unburden their distressing feeling and/or beliefs.

Looking at BIID through the IFS lens affords realistic hope, I believe, for
relieving much of the misery. It seems to me that, given that the negative
feelings towards body parts emerge during childhood that we're looking at young
"parts" of the system seeking to get attention. Other parts have a long-term
critical or adversarial relationship with the offending body part: "If it wasn't
for you I'd feel whole. You are a burden to me. My life would have been so much
better without you."

I'm aware of the pitfalls of comparing apples and oranges but this
interpersonal dynamic is not dissimilar from the fat kid's internal berating,
"If only you weren't such a pig we'd have more friends", or the gay kids, "If
you weren't so faggy we wouldn't get beaten up all the time."

What the IFS perspective offers is a new way to break out of this tired and
habitual dance. What happens when we acknowledge the critical punitive voice as
a protector? When we appreciate it for its role? When we ask it how it likes its
job? In my experience these young parts are often tired and would like some time
off – but feel they can't stop what they are doing. If assured that it is safe
for them to temporarily step aside while we spend time with the part they are
connected to they may allow us in. When we then bring our compassion to the
young part that is suffering we can hear what is going on for it.

It may have tremendous sadness about not fitting in, fear of being hurt, it
might be mad at us for not listening to it sooner, it may hold painful memories
about exclusion. Whatever is going on for it if we listen to it with compassion
and curiousity it is no longer exiled and isolated but heard and validated. This
is itself provides relief and we may be able to help it release its pain. How
different might life have been had there been a trusted adult around for that
isolated part at the time of its difficulties. We now have the opportunity to
take on that role internally and facilitate change.

I know that opening to the possibility that the personality is a system can be
very challenging for many parts. Our manager parts especially like to run the
show and figure everything out. I also know that for some folks with BIID
surgery feels like the only option. It is also clear from watching" Whole" that
there can be great relief for some post-surgery.

Analogies have been drawn between transgender individuals and the "transabled".
It is true for many post-operative transsexuals that despite the huge
adjustments required they are now living lives as they feel they were meant to.
It is also true that for some the surgery was a costly an irreversible mistake
leading to a life lived with regret.

My hope is that a consideration of what the IFS method may have to offer members
of the BIID community will inform discussions and treatment options.