Chapter 33 · Canonical English edition

33. Where the Method Works, but Slowly or with Limits

Functional Systems Facilitation · Dmitry Shamenkov

Section 43 of 53version 1.1 · July 2026Source: Book_OD
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33. Where the Method Works, but Slowly or with Limits

In some conditions FSF does work — not as a source of fast results, but as a mode of long-term support. Here it matters to set expectations correctly.

Chronic Trauma with Dissociation

In chronic trauma — especially early, repeated trauma that arose where no protecting adult was present — a person often develops dissociation: a splitting between different parts of experience, in which feelings, emotions, and bodily sensations recede into regions inaccessible to consciousness.

FSF can be part of the path to recovery in such cases, but it cannot be the only method, or even the primary one. Dissociation calls for:

  • Long-term individual work with a trauma specialist (somatic experiencing, sensorimotor psychotherapy, EMDR, Internal Family Systems (IFS));

  • A very gentle pace — opening up too quickly in a group can retraumatize;

  • Possible pharmacotherapy during acute phases.

In these cases my facilitators and I work in partnership with clinical specialists: FSF provides a safe space and a community, while individual trauma therapy does the specific work with the dissociated material.

Personality Disorders

In pronounced personality disorders — especially borderline, narcissistic, and antisocial — the group format on its own is insufficient, and at times even counterproductive. Parallel specialized individual work is required: Dialectical Behavior Therapy (DBT) for borderline personality disorder, Mentalization-Based Treatment (MBT), schema therapy, or another approach with an evidence base for the specific disorder.

This does not mean a person with such a diagnosis cannot take part in FSF. They can — but on the clear understanding that the group method supplements specialized work rather than replacing it.

Acute Crisis States

In acute suicidal ideation, acute psychotic symptoms, severe depression with risk, active addiction in a phase of acute craving, or an acute psychotic episode, the first line of help must be specialized medical care, not an FSF group.

A simple principle applies: stabilization first, development afterward. FSF is developmental work, and development is impossible from a state of acute threat to life. In an acute phase what is needed is stabilization — and for that there are separate services and separate specialists.

After stabilization — yes, a person can gradually enter the program. But not during an acute crisis.

Chronic Physical Illnesses

In serious chronic physical illnesses (cancers, cardiovascular, endocrine, autoimmune, and neurological conditions), FSF supplements but does not replace medical treatment. The epidemiological evidence I cited in Part I — improved survival with social support — indicates that quality of life and psychological well-being are a meaningful factor in the course of an illness. But a factor is all it is: not an alternative to an oncologist, a cardiologist, or an endocrinologist.

I have heard many times from participants that FSF helped them relate differently to their diagnosis, reconsider their priorities, restore relationships with loved ones in the midst of illness. That is enormous value. But any attempt to use the method as an “alternative” to evidence-based medicine is an ethical and factual violation, and one I oppose directly.