Treating OCD with Internal Family Systems Parts Work

Just a word about treating OCD with IFS versus Exposure and Response Prevention (ERP). Treating obsessive and compulsive parts with IFS is diametrically opposed to treating it in the Exposure and Response Prevention, the most commonly recommended approach. IFS treats OCD parts as what they are–managers and fire fighters, they have jobs to do. If you can help the exiles underneath these protectors, there will be less need for the OCD behaviors. (This might be complicated if there are still constant stressors in the client’s life, for which they need the protection.)
IFS does work, and I have successfully treated people with full blown OCD who now have about 5% of their original symptoms only during moments of high stress, and they do not consider themselves OCD anymore. These clients have been helped by taking SSRIs as well, which I will say more about below.
ERP works to suppress those same protectors that IFS seeks to understand/care for. It does “work”, as people get a strategy for the thoughts that are driving them nuts, but the folks I know who have gone through this treatment find they have to do their ‘homework’ forever or the OCD comes back, and they always feel it threatening. In short, it is stressful, and the fight is never over.
For anyone doing ERP, they have to commit fully to that approach, the homework is hours a day, and one cannot be halfhearted about it or it won’t work. The good thing about ERP is that it gives people some control, which they strongly desire, because they feel so powerless.
Finally, since OCD has a strong genetic component and it can also be caused by strep infections in childhood (PANDAS) https://www.nimh.nih.gov/health/publications/pandas/index.shtml, often medication is necessary. Medication is usually recommended in combination with ERP, and I believe it helps the client who is doing IFS for their OCD as well, especially to help them in the early days feel more hopeful and in control. It may be phased out or cut down later as the parts work progresses in some clients, but not all.