Aphantasia and IFS

Hi everybody, it's Mary the OG Woo Woo Therapist and as always everything that I'm going to talk about today does not take the place of therapy or counseling. And if there is anything in today's podcast that you find you may need to investigate further, please contact a licensed therapist near you.

So today I'm going to talk about something in response to a question I got from podcast one. The question was does aphantasia which is the inability to voluntarily generate a visual mental image, does that interfere with autobiographical recall of information?

And no, it does not.

The facts are still in the mind. The emotions are still in the mind. And so when we're talking about autobiographical recall, especially with trauma, the individual is absolutely capable of remembering whatever it is that is in the brain for them to remember.

What aphantasia is, is that when people are asked to bring a mental image to mind of it they are incapable of doing that so, people with aphantasia do not, they just don't see pictures in their mind. Aphantasia exists on a spectrum from absolutely no imagery at all to very faint imagery. And it is not a disorder by itself. It is a neurocognitive variation. It is not a neurodivergence. It is a neurocognitive variation.

So what Aphantasia is not, it's not a lack of imagination. It's not a memory deficit because, like I said, the words and the feelings are still in there and able to be recalled, it is not dissociation or repression, and it's not a visual processing problem. The eyes and the vision are still normal. They're just not able to close their eyes and have a picture in their mind, and it is not necessarily trauma-related.

However, in my case, I learned about aphantasia from working with someone who did have a diagnosis of CPTSD and we were doing an exercise that I use with folks called The Meeting Space. And so, I asked him to close his eyes and imagine or bring to mind a place that would be a good meeting space for all of his parts, regardless of how old they present. And when he closed his eyes, he closed his eyes really tight and he got this look on his face that looked like he was in a little bit of pain.

And in my family, when somebody gets that look on their face, we know they're thinking because that is our assumption. “Oh, you look like you're in pain. You must be thinking.”  But that was not the case with this guy. He was just working really hard to try to bring a picture to mind, and he couldn't.

So, what I had to do was give him a piece of poster board and then he drew on the poster board what he deemed as a meeting place and then he labeled everything in there. He drew a square for the table and then put X's around it for chairs, then furnished the rest of the room.  And he did all of the rest of the stuff that I asked him to do in building the meeting place. So, once he externalized it, he was perfectly capable of doing what I was asking him to do.

One of the interesting things about aphantasia is that it's usually discovered in adulthood. The common triggers are where we're asking people to do guided imagery or meditation. So...when I ask them, especially with hypnosis, to close their eyes and then imagine that they are someplace. They're incapable of doing that. Just because their brain doesn't do pictures inside the mind but can put them outside the mind, like the therapy exercise that we did where I was asking him to bring to mind a meeting place. Then it is necessary to have discussions about mental pictures.

One of the ways I discover Aphantasia is when I ask people, when they're trying to explain something and they're having difficulty with the words, I ask them to just bring to mind a mental picture of that and then describe the picture to me. Then when they're not able to bring a mental picture to mind I can assume there is some aphantasia. A lot of times many will use metaphorical language until it's contrasted with others experiences. I use a lot of metaphor and that kind of stuff especially with hypnosis where I will tell a story to someone who is in trance and use a metaphor to talk about what it is that we're doing the hypnosis for and people who are incapable of the mental images don't really deal with bringing some kind of picture to mind of the metaphor that I'm telling them, but they absolutely understand the words of what I'm telling them.

So it is primarily visual imagery that is affected with aphantasia. Other imagery domains are auditory, where we have an inner voice or we're able to imagine what sounds sound like. Kinesthetic or movement where we can imagine moving our arm or something like that or what a pin prick feels like or tactile sensation. The olfactory or gustatory, where we can imagine the smell so it's like when growing up if you came home and mom or grandma was cooking something. My thing that always takes me back to my childhood is when I smell frying onions. We used to have fried onions in our food a lot when I was growing up. And that's not a complaint. I absolutely love fried onions. And I love the smell of them because it takes me back to those pleasant memories. And it doesn't bring a picture to mind necessarily. But it reminds me of being a certain age and coming home and smelling the onions cooking and knowing that we were going to have something good to eat for dinner.

The other thing is that some individuals have global imagery absence where they are not able to bring to mind these other types of imagery domains like hearing or imagining sound that they heard or you know, being able to smell onions and have some kind of connection with some kind of memory because the imagery is just absent, not the memory. The other thing is that a lot of times when I ask people to bring to mind a pleasant memory of coming home from school and their mom baking cookies. When I ask them, what does that smell like they're not able to imagine the smell but remember that there was a smell that they thought was good at the time and they'll just tell me it smelled like baked cookies. So sometimes the other imagery domains are affected as well.

When we talk about memory and cognition when it comes to aphantasia, autobiographical memory may be more conceptual, factual or narrative and less sensory or scene-based. So when somebody is giving me a recount of something that happened, they will have the words for it, it will be factual and they'll tell it like a story sometimes even in third person. But they do not have any kind of focus on the scene.

 I can ask them when they're telling me about something that happened, I can ask them, what room were you in? Then they can tell me what room they were in. And if I ask them what was in the room, then they can tell me what was in the room. But that's not part of the factual recall of the actual incidents, because that is part of the scenery of the incident and less important than the actual facts or the narrative of what happened.

A lot of times, future thinking often relies on planning, logic, and verbal rehearsal, but there is no imagine what it would be like too…. and dream imagery can be present or absent, it depends on the individual. What that means is that people sometimes can recall their dreams and be able to describe what was happening in the dream image but they don't get an image of it in their mind.

The other thing is, is that emotions are fully present with Aphantasia when they talk about autobiographical information. Emotional recall may be less vivid, but it's not any less meaningful. Some report that imagery is less intrusive and that they have lower rates of visual flashbacks when it is related to trauma.

Others experience emotion through somatic or cognitive pathways where they might have recall, but instead of having the visual image of it, they can feel it in their body.

Let’s look at Aphantasia versus poor visualization. With poor visualization there's faint or unstable imagery and with aphantasia there's no voluntary visual imagery. When we look at aphantasia versus dissociation we see that dissociation involves altered consciousness or lack of memory integration where aphantasia is a stable trait like and present across all contexts. Aphantasia versus alexithymia, alexithymia is difficulty identifying emotions aphantasia is difficulty generating an image but where the emotional awareness is intact.

So some of the implications for therapy is that visualization basic techniques are ineffective and frustrating for the client. The common impacted modalities are guided imagery, EMDR visualization, hypnosis imagery scripts and inner child imagery exercises. So, when I ask people to close their eyes and see that inner child part of them they're incapable visualizing their inner child. However, they may be able to feel the presence of the inner child in their body. And the other thing is, that clients may feel confused, defective, or excluded unless we actually talk about their inability to have a visual image. A lot of times like with this guy that I talked about originally, he thought something was wrong with him and that maybe he sustained some kind of injury to his head that prevented him from being able to have a visual image of what we were talking about. So when we talked about aphantasia then he was able to understand that it was just something that  his brain can't do then he was fine with it.

Therapy adaptations that work well for someone with aphantasia is the use of somatic, emotional, cognitive or symbolic approaches. I replace the word “see” with notice, sense, know, or describe. then we can use external aids that are written descriptions, objects, drawing or diagrams, and metaphors without visual demand. That way we can talk about a story.

For example, one of the things that I talk about when I'm working with somebody who wants to eliminate a bad habit is the use of metaphor with hypnosis. A lot of times I'll use the story of the fox and the grapes, where the fox really wanted those grapes, and then when he finally got them, he found out they were sour. I will use that story as a metaphor a lot of times to bring down the desire for the use of the drug or the substance or the behavior, whatever it is the dependence is about. They're able to understand the story and be able to know what I'm talking about without having to visualize it. Then that allows for focus with people with aphantasia on the meaning, the felt sense, narrative memory, and body-based awareness.

strengths that are commonly reported by people with aphantasia is that they have strong analytical thinking and they have good factual recall. They are highly verbal and have good logical reasoning with reduced susceptibility to intrusive imagery. That has a lot to do with the people I work with who have aphantasia, they are less prone to visual flashbacks. Another strength is that they have effective problem-solving strategies.

One of the things that we talk about is client facing normalization language. Language that can be used to make this normalized or for them to feel less excluded is talking about how their brain processes imagery differently. Not that his brain is broken, it just processes differently and it stores memories as words. I also reassure them that they can do deep emotional work without pictures.

Many therapies can be adapted to how their mind works. So with EMDR when they can't bring to mind a mental image then I ask them to just remember the event so it occurs to them what ever domain the memory is prominent in, usually it is in narrative form.

Then we can talk about how disturbing it is to remember that event or to remember a time when they felt like this or when that thing happened and they're able to do that so it is quite effective to do EMDR with folks who do not get visual images.

I have a client today that when I ask them to bring to mind an image, then they bring out their notebook and write it down. In that way, they’ve got the memory of the image there.

So, one of the things that, as a therapist, I need to know is when to screen or clarify that maybe aphantasia is something that's going on with my client. And that is when they have repeated difficulty with imagery tasks. I don't usually go to a second time. If they tell me they just can't get an image, then I just assume that we're talking about aphantasia and then I go to one of the alternatives that they can use. Sometimes they will seem confused or disengaged during visualization exercises and that is an indicator that imagery is a problem.

one of the things that I had to get to a place of knowing when my clients have that pained look on their face, it's because they're usually incapable of bringing an image to mind. I stop and ask them, “are you having difficulty with bringing the image to mind?” And usually, always, they say yes. Then I also have to be aware when I hear client statements like I don't see anything or I don't know what you mean by picture it that there is something going on there as well.

one of the things I can use is a brief screening questions about what happens when i ask you to bring the mind bring the mind an image of a beautiful lake with the sun glinting on the water. They will look at me and go, I've seen a beautiful lake with sun glinting on the water, but I can't bring a picture of that to mind, but I know I've seen it. And then that tells me that we're working with Aphantasia.

So, the key takeaways from this discussion on aphantasia is that it is a normal neurocognitive variation. It affects how people imagine, not whether they can heal. And therapy is most effective when methods match cognitive style. clarity reduces shame and increases engagement. When I understand that somebody may have Aphantasia and are not able to do mental imagery, then I have alternative ways of working with them that are just as effective and can bring the same kind of healing.

 The next thing I'd like to talk about today is to do a brief overview of Internal Family Systems, or IFS.

One of the things about IFS is that the core idea is that the mind is made up of multiple parts. Not a single monolithic personality, if you will. And, the parts are normal, adaptive, and meaningful.

With IFS, they assume everyone has a self, which is the core state of calm, clarity, compassion, and leadership.And symptoms are expressions of parts trying to protect the system or the self. The role of the self is that it is not a part.

The Self qualities are the eight C's. the eight C's  that comprise the self are calm, curiosity, compassion, confidence, courage, creativity, clarity, and connectedness. Healing occurs when the parts relate to self rather than to each other. Therapy focuses on increasing self-leadership, not eliminating the parts.

The categories of the parts are exiles, they carry the wounds, trauma, shame, fear, and grief, of the experiences from the past. And they're often frozen in time. Often referred to them being stuck in that trauma moment. Typically, they are pushed out of the awareness by the self and they activate when something resembles past pain.

Next, we have protectors. They're there to protect the system from feeling the pain of the exiled parts. Then there are the managers and they’re proactive, controlling, and preventative in their work. Some of the examples for controlling and prevention would be perfectionism, hypervigilance, people pleasing, and intellectualizing. Then we have the firefighters. They are reactive and they are urgent and crisis driven. Some examples of that would be dissociation, binging, substance use, self-harm, and shutdown.

How the symptoms are understood in IFS is that the symptoms are protective strategies, not dysfunctions. Extreme behaviors arise when parts are overburdened, afraid of exile activation, and / or lacking trust in self-leadership. Removing symptoms without understanding parts can increase the distress in the system. So the therapeutic stance that we take when working with internal family systems is non-pathologizing, so we don't make it a disorder or a diagnosis. They way we work is curious, respectful, and collaborative, and we believe there's no such thing as a bad part.

The therapist relates to the client's self, not their parts. Parts are approached with permission, never forced. What the healing process looks like is that if I want to work with a part, then I work with that part through the self. I ask the self to ask the part that uses alcohol, for example, to come forward and speak to me through them. Then the part will either agree to do that or not.

The first step in the healing process in ISF is to identify and differentiate the parts and unblend the parts from the self, build trust with the protectors to gain access to exiles safely, and witness the exile’s stories. Then retrieve and unburden the exiles and help protectors release extreme roles or integrate new roles under self-leadership.

In unburdening, we would consider burdens of the exiles, the beliefs, emotions, and sensations taken on during trauma. It's not the part's identity, it's their experience. Often these parts are burdened also with shame, fear, worthlessness, and the responsibility or feeling responsible for what happened to them.

Unburdening uses symbolic imagery and somatic awareness. Symbolic imagery is what we just talked about with aphantasia. a lot of times we have to modify this by asking “do you sense or do you notice?” And then we connect to the somatic awareness of what's happening in their body. Then it usually results in a spontaneous shift in the protector.  When we're talking about IFS and trauma it is held in exiles and that is managed by protectors.

IFS emphasizes safety before exposure. Protectors decide the pacing. When we work with it, we avoid re-traumatization by preventing overwhelm in the exiles. It is particularly useful for developmental trauma or the things that we experience as we're growing up that relate to the stages of development, which is CPTSD, which I talked about in a previous podcast and attachment trauma which I will talk about in a future podcast

IFS and dissociation is the highest level of polarization or compartmentalization with IFS. Dissociation is often a firefighter strategy to protect the self. IFS can work gently with dissociation when there is sufficient self-energy and the parts trust the process. It may need modifications or adjunct approaches for severe structural dissociation. a lot of work that goes into building trust with the parts to trust the process. But, first they have to trust me as a therapist and then they need to trust the process.

Common misconceptions that I have to address with people are:

1.      that IFS means I have multiple personalities, which it does not.

2.      that parts are imaginary, which they are not,

3.      the goal is to get rid of the parts, which it is not.

4.      and that the self equals positive thinking, which it does not.

Most clients often find IFS helpful because it reduces shame. It makes the internal experiences understandable and it validates survival strategies. It also creates internal cooperation instead of internal conflict, which is really important in the healing process. But most of all it empowers clients to become their own healers.

A sample of client facing language would be, instead of asking, asking what's wrong with me, we ask what happened and how did my system adapt?

We don't try to eliminate parts. We help them feel safe enough to relax.

When your system trusts the self, symptoms often soften naturally. And sometimes the symptoms even will dissipate.

Therapy adaptations, again, with some of the internal parts that we can use, have to do with the use of the word notice sense and those kinds of things because it is not unusual for folks with IFS to also has aphantasia, where they cannot get an image of the part. Which is okay because we can still do the healing with IFS’s process of healing.

There is intensive training available for therapists to work with internal family systems. I have only done basic competency training and I have a very brief knowledge of it. I have not been fully trained in or certified in IFS to be able to do it with my clients. However, we can talk about the internal parts as the firefighters, the exiles and that kind of stuff as it relates to dissociation. One of the things that I do with my clients frequently is help them understand that dissociation is an amazing ability of the brain to protect itself in a very intense traumatic situation.

So when we're talking about the different ways of identifying and working withpeople who have parts. IFS is the very basic strategy that we can use. when there’s anything that's on the upper continuum of dissociation like severe structural dissociation or DID then we have to / can use other therapies which I'll talk about in a future blog.

So that does it for today. I hope you enjoyed this talk today. If it feels a little more disorganized than usual, it's because I just wanted to talk about what I know about these things rather than to present formal information where it sounds like I am an expert or that I am certified with IFS when I'm not. It’s just easier for me to talk about it, tell you what I know, and then we can go from there.

If you're interested in doing internal family systems work, find a therapist near you. If you want to go to the Psychology Today Find a Therapist area, and at the top you can put in the things that you're looking for in a therapist. And one of the things you can do is identify a modality like IFS and it will generate a list of names of therapists near you that do IFS.

With that, I hope you have a great week, and I will talk to you all next week. If you enjoyed today's content, please give it a like. And if you are interested in hearing more, subscribe so that you'll be notified when there's a new podcast. Thanks for listening.