The OCD Stories, Episode #511

Melissa Mose: Integrating IFS and ERP for OCD
Released: November 9, 2025

Episode Overview

In this episode of The OCD Stories, host Stuart Ralph welcomes back licensed marriage and family therapist Melissa Mose to discuss her new book and pioneering clinical work in integrating Internal Family Systems (IFS) therapy with Exposure and Response Prevention (ERP) for treating OCD. The conversation explores what IFS is, how it complements ERP, the concept of "parts" in therapy, and practical strategies for both clinicians and individuals with OCD. The episode maintains a conversational and optimistic tone, highlighting the importance of therapeutic creativity, compassion, and the evolution of OCD treatment.

Key Discussion Points and Insights

1. Melissa’s Evolving Work and New Book

• Melissa recently published Internal Family Systems Therapy for OCD: A Clinician’s Guide (Sept 8), which blends IFS and ERP approaches (03:08).
  • "It's been wonderful to see both communities really welcome this approach... It's just such a great fusion." — Melissa, [04:08]
• She is also working on a user-friendly workbook for individuals, aiming for release in Fall 2026 (04:47).

2. What is Internal Family Systems (IFS)?

• IFS, developed by Dick Schwartz, is based on the idea that everyone has multiple "parts" — aspects of the psyche with different roles and intentions (05:54).
• The "Self" is a centered, curious leader among parts, which naturally emerges when parts relax.
• Unlike some therapies aiming to eliminate symptoms, IFS focuses on acceptance and balance among parts.
  • “It's about finding a balance. It's about being actually the self in the leadership role, the parent in the room, the CEO, the one who guides the parts, rather than parts leading.” — Melissa, [08:31]

3. How IFS and ERP Fit Together

• Melissa's clinical history combines psychodynamic, family systems, and mindfulness approaches.
• Personal experience (her daughter’s severe OCD and ERP recovery) motivated her to train in ERP and later integrate IFS.
• Both IFS and ERP value "turning towards" discomfort with curiosity, making them compatible (13:34).
  • “If you think of [exposure] as turning towards the thing you've been avoiding with openness and curiosity and a willingness to learn, that's exposure. It's also exactly what ifs is all about.” — Melissa, [13:36]
• Viewing distressing compulsions and intrusive thoughts as "parts" can help clients unblend from them, reducing struggle.

4. Self-Compassion and Working with "Blocks"

• IFS facilitates self-compassion not as an abstract idea, but as a practical skill directed toward individual parts (15:19).
  • “If you really can help someone, see, well, there's a part of you that does these things because it feels like it has to and you don't like it. So there's the you in there, right?” — Melissa, [15:38]
• When clients are "blocked" from engaging in exposure, IFS focuses on understanding and negotiating with resistant parts, instead of brute-forcing through the block.
  • “Instead of trying to get rid of the block or the 'resistance', let's get really curious about it... Then you get to where you can negotiate with these parts of you, and they soften a little bit just by virtue of being heard.” — Melissa, [18:14]

5. The Practicalities of IFS in Therapy

• Not all IFS is about "talking to parts as if they're people" — often, it involves simply listening and sensing what comes up internally (23:34).
• The practice is relational: clients might use metaphor, imagery, or simply curiosity to approach parts.
  • "If you pose the question, what is the message here?... and you just listen instead of think. A different kind of answer comes." — Melissa, [23:46]

6. Intuition, Doubt, and Differentiating OCD

• The more clients distinguish the voice/feeling of OCD from their core Self or intuition, the more they can trust their genuine instincts (26:54).
  • “The brilliance of ifs is you begin to develop a sense for the sound of OCD thoughts in your head…and you can then get in that space where intuition, there’s more room for intuition because you know the quality of that thought.” — Melissa, [27:17]
• Over time, unblending from intrusive parts allows more access to values and direction—core aspects of ACT, relational therapies, and IFS overlap (28:10).

7. Destigmatizing OCD: No Bad Parts

• The “parts” model helps de-stigmatize OCD by externalizing symptoms: clients see themselves as whole, not "broken" (46:56).
  • “I'm not pathetic because I can't do these things… It's not me. There are parts of me that are basically overprotective." — Melissa, [47:28]
• Even highly destructive, shameful, or suicidal parts are framed as (misguidedly) protective, reducing internalized shame.

8. Integrating IFS Into ERP Sessions

• Melissa adapts her approach based on client needs. Sometimes classic ERP is "infused" with parts-awareness; other times, IFS is foregrounded with ERP principles layered in (40:11).
• Identifying, listening to, befriending, and negotiating with parts becomes central to both readiness and implementation of exposures.

9. Transdiagnostic and Relational Applications

• IFS plus ERP is effective for clients with complex comorbidities (e.g., trauma, addiction), as the "parts" language allows tailored, nuanced work across problems.
• The approach also benefits clients post-ERP, who still need to navigate relationships or life decisions without triggering OCD relapse.

10. Resonances with Other Therapies

• There’s considerable overlap with ACT’s diffusion and self-as-context, as well as with mindfulness and relational therapies (NALGBT, FAP).
• Using parts language promotes distance, perspective, and flexibility (51:25).

Notable Quotes and Memorable Moments

• On the spirit of clinical exploration:
  "That's why I think AI is not going to take over therapists because... we're curious and we evolve and we have these other things that we bring and it's not going to be for everybody. But for the people that are needing something more, it's a really valid and really healing way to go." — Melissa, [54:27]

• On self-leadership:
  "It's about being actually the self in the leadership role... the parent in the room, the CEO, the one who guides the parts, rather than parts leading." — Melissa, [08:31]

• On parts and self-compassion:
  "It really does come up naturally... you really do start to have compassion for parts of yourself who are working so hard to protect you in this really awful, counterproductive way." — Melissa, [16:24]

• On internal dialogue during exposures:
  "I can notice, like, hey, did a part just come in? Yeah, I’m starting to get really intimidated about this... Okay, so turn to that part, ask it to step back, and then we go back into the exposure." — Melissa, [29:24]

Key Timestamps for Important Segments

• New Book Announcement & Backstory........................ [03:08–05:26]
• IFS Explained.................................................................. [05:54–09:28]
• Melissa’s Path to IFS + ERP Integration........................ [09:52–15:10]
• IFS for Blocks, Resistance, and Self-Compassion............ [17:15–22:06]
• How IFS Engages with 'Parts' (Practice Models)................ [23:16–25:19]
• Intuition, Doubt, and OCD's Voice................................... [25:19–32:09]
• Observing Parts in Session / Embodiment........................ [33:47–36:26]
• Relational vs. Behavioral Models / Therapy Structure......... [38:51–46:19]
• IFS Destigmatization & No Bad Parts.................................. [46:35–50:59]
• ACT, Diffusion and Parts Language................................... [51:25–53:27]
• Therapist Creativity and Healing.......................................... [54:27–55:58]

Final Reflections

Melissa Mose’s integration of IFS and ERP offers a compassionate, intuitive pathway for both clients and therapists navigating OCD. By reframing symptoms as "parts" with positive intent—even if misguided—she opens doors to self-understanding, readiness for exposure, and profound shame reduction. Her work is a testament to the value of clinical creativity, relational depth, and inviting curiosity not only towards symptoms, but toward the full complexity of our inner lives.

For resources, recordings, and upcoming conferences, visit OCD SoCal or check the episode’s show notes.